How much does Medicare pay for CPT 52001?

Medicare allowed an average of $412.95 per service and paid $327.87 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1378.57, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52001?

Irrigation and removal of multiple blood clots from bladder and urethra using an endoscope. It was billed 1,518 times to 1,330 Medicare beneficiaries by 57 providers in 2024.

Does 52001 pay differently in an office than a hospital?

Yes. The allowed amount averaged $380.37 in an office setting and $436.96 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 52001 most?

Urology, with 1,320 services from 50 clinicians. Next are Ambulatory Surgical Center, Obstetrics & Gynecology, Internal Medicine.

CPT 52001

Irrigation and removal of multiple blood clots from bladder and urethra using an endoscope

$412.95Medicare-allowed amount per service, averaged across 1,518 services

Providers submitted

$1378.57

Asking price, not received

Medicare allowed

$412.95

The fee schedule figure

Medicare paid

$327.87

Balance is patient coinsurance

Providers submitted an average of $1378.57 for this code and Medicare allowed $412.95 — 3.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $327.87 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $380.37
Hospital / facility: $436.96

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 644 services were billed in an office setting and 874 in a facility.

Services: 1,518
Beneficiaries: 1,330
Providers billing it: 57
Total allowed: $626,858

What Medicare pays for CPT 52001

Across 1,518 services billed by 57 providers to 1,330 beneficiaries, Medicare allowed an average of $412.95 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 52001

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	1,320	1,161	$313.02	50
Ambulatory Surgical Center	136	107	$1490.59	3
Obstetrics & Gynecology	51	51	$151.56	3
Internal Medicine	11	11	$292.71	1

52001 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	465	$320.24	$212.69	11
New Jersey	180	$307.00	$209.93	5
Maryland	180	$893.48	$722.50	3
California	108	$377.98	$256.06	5
Texas	84	$352.33	$280.53	3
Pennsylvania	66	$305.06	$234.30	3
Mississippi	53	$713.80	$677.25	3
Arizona	44	$233.32	$177.34	2
New York	40	$1055.47	$871.01	2
Oklahoma	37	$237.66	$194.14	3
South Carolina	37	$269.84	$210.00	3
North Carolina	37	$426.72	$336.02	1
Kentucky	27	$265.37	$220.51	1
Indiana	27	$237.99	$207.96	2
Georgia	17	$262.49	$126.16	1
Utah	16	$241.47	$191.25	1
Louisiana	15	$279.45	$220.56	1
Ohio	14	$270.01	$220.01	1
Virginia	13	$264.98	$202.65	1
Missouri	13	$247.86	$155.60	1
Massachusetts	12	$239.68	$148.81	1
Arkansas	11	$235.39	$181.66	1
Vermont	11	$139.81	$109.70	1
Colorado	11	$261.01	$194.65	1

Related codes

52000Diagnostic exam of bladder and urethra$200.11
52005Insertion of tube into ureter$255.90

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.