How much does Medicare pay for CPT 52204?

Medicare allowed an average of $415.75 per service and paid $327.42 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2408.53, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52204?

Biopsy of bladder using an endoscope. It was billed 8,178 times to 7,381 Medicare beneficiaries by 375 providers in 2024.

Does 52204 pay differently in an office than a hospital?

Yes. The allowed amount averaged $355.60 in an office setting and $421.62 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 52204 most?

Urology, with 4,873 services from 252 clinicians. Next are Ambulatory Surgical Center, Obstetrics & Gynecology, Physician Assistant.

CPT 52204

Biopsy of bladder using an endoscope

$415.75Medicare-allowed amount per service, averaged across 8,178 services

Providers submitted

$2408.53

Asking price, not received

Medicare allowed

$415.75

The fee schedule figure

Medicare paid

$327.42

Balance is patient coinsurance

Providers submitted an average of $2408.53 for this code and Medicare allowed $415.75 — 5.8× 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 $327.42 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $355.60
Hospital / facility: $421.62

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 728 services were billed in an office setting and 7,450 in a facility.

Services: 8,178
Beneficiaries: 7,381
Providers billing it: 375
Total allowed: $3,400,004

What Medicare pays for CPT 52204

Across 8,178 services billed by 375 providers to 7,381 beneficiaries, Medicare allowed an average of $415.75 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 52204

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	4,873	4,326	$152.38	252
Ambulatory Surgical Center	3,229	2,982	$819.43	118
Obstetrics & Gynecology	56	56	$96.56	4
Physician Assistant	20	17	$304.78	1

52204 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	1,313	$387.85	$317.71	54
Illinois	500	$214.74	$158.18	19
Mississippi	471	$494.38	$444.80	12
Georgia	446	$554.75	$443.62	22
Pennsylvania	436	$335.76	$260.33	22
New York	417	$394.50	$273.60	21
California	413	$456.61	$290.08	18
New Jersey	405	$549.04	$412.99	22
Maryland	383	$593.11	$471.86	20
Tennessee	359	$411.28	$365.57	15
Ohio	337	$514.62	$432.93	12
South Carolina	312	$369.99	$310.07	14
Virginia	233	$454.93	$371.28	10
Massachusetts	212	$310.28	$232.75	12
Texas	194	$534.21	$438.49	9
Arizona	176	$308.96	$239.93	9
Indiana	167	$376.03	$303.52	10
North Carolina	139	$257.79	$204.24	9
Kansas	139	$482.00	$411.56	7
Michigan	133	$316.87	$256.06	7
Washington	105	$558.31	$394.02	4
West Virginia	102	$120.56	$93.49	6
Oklahoma	100	$116.60	$89.97	5
Arkansas	85	$526.42	$461.29	4
Missouri	84	$614.44	$512.21	3
Iowa	81	$261.83	$223.70	2
Delaware	69	$773.18	$589.62	3
Nevada	51	$387.87	$310.61	3
South Dakota	47	$112.05	$90.51	3
Colorado	44	$863.84	$696.07	3
Kentucky	42	$135.61	$104.57	2
Nebraska	38	$497.10	$399.53	2
Wisconsin	23	$109.73	$85.59	2
Alabama	18	$120.66	$102.63	1
Connecticut	16	$384.59	$293.77	1
Minnesota	14	$105.28	$76.88	1
Alaska	13	$147.23	$94.33	1
Louisiana	13	$123.92	$102.62	1
Wyoming	13	$83.04	$63.62	1
Utah	12	$351.29	$295.16	1
Idaho	12	$691.10	$577.09	1
Rhode Island	11	$856.90	$695.81	1

Related codes

52287Exam with injections of chemical for destruction of bladder using an e$382.62
52281Dilation of urethra$396.69
52224Destruction of growth of bladder and urethra$754.81
52235Destruction and/or removal of growth of bladder and urethra$613.17
52234Destruction and/or removal of growth of bladder and urethra$719.29
52240Destruction and/or removal of large growth of bladder$789.42
52214Destruction of tissue of bladder$622.35
52260Dilation of bladder$396.90

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.