1. Urology was represented in 23 percent of all ASCs in 2008.
2. Urology ranked fourth among specialties in average number of annual cases performed at single-specialty centers — behind gastroenterology, pain management and oral surgery — with 3,426 cases.
3. Although a majority of urologic procedures are still performed in hospitals, cases are shifting over to surgery centers, as a result of growing reimbursement rates for surgery centers. Listed below are some common procedures, their reimbursement rates in 2007, 2008 and the projected rate for 2011.
- Prostatectomy, first stage (CPT 52612):
- 2007: $446
- 2008: $701.91
- 2011: $1,493.64
- Prostatectomy, second stage (CPT 52614):
- 2007: $333
- 2008: $623.16
- 2011: $1,493.64
- Laser coagulation of prostate (CPT 52647):
- 2007: $1,339
- 2008: $1,472.13
- 2011: $1,871.50
- Laser vaporization of prostate (CPT 52648)
- 2007: $1,339
- 2008: $1,472.13
- 2011: $1,871.50
4. The average net revenue for a urologic procedure in 2008 was $1,649. The highest average net revenue was in the West ($1,557/case) and the lowest was in the Northeast ($1,011/case).
5. The average net revenue changes by the number of operating rooms in a surgery center. The average net revenue for urology cases by number of operating rooms is as follows:
- 1-2 ORs: $1,059
- 3-4 ORs: $1,242
- More than 4 ORs: $1,184
6. The average net revenue changes by the number of cases a center performs annually. The average net revenue for urology cases by number of cases performed is as follows:
- Less than 3,000: $1,248
- 3,000-5,999: $1,210
- More than 5,999: $1,184
7. The average net revenue changes by the total net revenue of the surgery center. The average net revenue for urology cases by total net revenue of the surgery center is as follows:
- Less than $4.5 million: $1,077
- $4.5-$7 million: $1,301
- More than $7 million: $1,342
Medicare charges and payments
Here is the average 2007 Medicare sub charge (submitted charges divided by allowed services), average allow charge (Medicare-allowed charges divided by allowed services, including co-pays and deductibles paid by patient), and average payment (Medicare payments divided by allowed services, not including co-pays and deductibles paid by patient) for 15 urology procedures commonly performed in ASCs.
8. Scope of bladder and urethra, for diagnosis (CPT 52000)
- average sub charge: $963
- average allow charge $328
- average payment: $257
9. Scope bladder, insert tube for injection (CPT 52005)
- average sub charge: $2,164
- average allow charge $388
- average payment: $306
10. Scope bladder, removal of lesions, small (CPT 52224)
- average sub charge: $2,104
- average allow charge $430
- average payment: $339
11. Scope bladder, removal of tumors, small (CPT 52234)
- average sub charge: $2,381
- average allow charge $439
- average payment: $347
12. Scope bladder, opening of bladder (CPT 52260)
- average sub charge: $2,106
- average allow charge $428
- average payment: $337
13. Scope bladder, open narrowed female urethra (CPT 52285)
- average sub charge: $1,291
- average allow charge $440
- average payment: $348
14. Scope bladder, simple removal stone, stent (CPT 52310)
- average sub charge: $1,520
- average allow charge $389
- average payment: $306
15. Scope bladder, complex removal stone, stent (CPT 52315)
- average sub charge: $2,534
- average allow charge $440
- average payment: $348
16. Scope bladder & ureter, insert stent into ureter (CPT 52332)
- average sub charge: $2,481
- average allow charge $352
- average payment: $279
17. Scope bladder & ureter, remove or move stones (CPT 52352)
- average sub charge: $3,085
- average allow charge $609
- average payment: $480
18. Scope bladder & ureter, break up kidney stone (CPT 52353)
- average sub charge: $3,808
- average allow charge $610
- average payment: $483
19. Surgery on bladder neck through urethra (CPT 52500)
- average sub charge: $2,585
- average allow charge $493
- average payment: $389
20. Opening of post-operative bladder neck narrowing (CPT 52640)
- average sub charge: $2,609
- average allow charge $437
- average payment: $348
21. Laser coagulation of prostate for urine flow (CPT 52647)
- average sub charge: $3,746
- average allow charge $1,316
- average payment: $1,044
22. Laser vaporization of prostate for urine flow (CPT 52648)
- average sub charge: $5,819
- average allow charge $1,330
- average payment: $1,048
Sources:
Items 1-3: SDI’s 2008 Outpatient Surgery Center Market Report.
Items 4-7: VMG Health 2008 Intellimarker.
Items 8-22: CMS.
Note: CPT codes are copyrighted by the AMA.
