How much does Medicare pay for CPT 52235?

Medicare allowed an average of $613.17 per service and paid $484.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2862.20, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52235?

Destruction and/or removal of growth of bladder and urethra using an endoscope, 2.0-5.0 cm. It was billed 10,585 times to 9,573 Medicare beneficiaries by 543 providers in 2024.

Does 52235 pay differently in an office than a hospital?

Yes. The allowed amount averaged $278.31 in an office setting and $617.21 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 52235 most?

Urology, with 7,538 services from 416 clinicians. Next are Ambulatory Surgical Center, General Surgery, Surgical Oncology.

CPT 52235

Destruction and/or removal of growth of bladder and urethra using an endoscope, 2.0-5.0 cm

$613.17Medicare-allowed amount per service, averaged across 10,585 services

Providers submitted

$2862.20

Asking price, not received

Medicare allowed

$613.17

The fee schedule figure

Medicare paid

$484.93

Balance is patient coinsurance

Providers submitted an average of $2862.20 for this code and Medicare allowed $613.17 — 4.7× 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 $484.93 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $278.31
Hospital / facility: $617.21

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 126 services were billed in an office setting and 10,459 in a facility.

Services: 10,585
Beneficiaries: 9,573
Providers billing it: 543
Total allowed: $6,490,404

What Medicare pays for CPT 52235

Across 10,585 services billed by 543 providers to 9,573 beneficiaries, Medicare allowed an average of $613.17 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 52235

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	7,538	6,802	$272.64	416
Ambulatory Surgical Center	2,944	2,677	$1496.47	124
General Surgery	90	82	$291.93	2
Surgical Oncology	13	12	$262.32	1

52235 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	1,400	$711.24	$588.41	64
California	756	$566.10	$382.98	45
Illinois	681	$478.62	$367.26	30
New York	630	$479.72	$334.48	28
Maryland	611	$944.27	$758.01	25
Texas	595	$585.82	$479.04	26
New Jersey	477	$823.02	$614.85	24
Tennessee	467	$683.93	$599.12	25
Pennsylvania	461	$537.76	$420.49	19
Virginia	384	$761.19	$646.81	14
Arizona	348	$536.75	$420.27	18
Massachusetts	341	$386.93	$296.73	19
Ohio	282	$460.23	$373.93	15
Indiana	275	$653.49	$535.60	18
South Carolina	244	$493.00	$406.75	14
Missouri	234	$750.03	$631.22	14
Kansas	200	$420.39	$351.42	13
Colorado	164	$1015.04	$809.10	9
Michigan	156	$500.92	$407.94	10
Minnesota	136	$263.34	$200.33	7
Washington	133	$624.08	$471.67	8
North Carolina	124	$410.87	$336.05	7
Mississippi	115	$935.34	$866.00	7
Kentucky	114	$473.01	$378.49	8
Georgia	113	$550.00	$433.63	8
Arkansas	113	$571.93	$482.14	8
Oklahoma	106	$384.37	$320.34	8
Iowa	93	$707.54	$621.59	5
Oregon	89	$1401.26	$1025.78	4
District of Columbia	88	$296.15	$198.07	4
Connecticut	73	$276.59	$199.26	4
New Hampshire	71	$270.81	$201.46	4
Delaware	67	$690.88	$524.24	4
Idaho	50	$751.56	$629.92	3
Alabama	46	$246.93	$208.94	3
Wisconsin	46	$252.31	$204.27	2
Nevada	40	$1080.53	$883.10	2
Montana	38	$233.56	$190.56	3
North Dakota	36	$250.91	$205.14	2
Louisiana	33	$681.65	$550.25	2
Vermont	28	$266.65	$207.61	1
Rhode Island	26	$273.63	$208.64	2
West Virginia	26	$262.93	$204.30	2
Utah	23	$237.79	$168.31	2
South Dakota	21	$257.47	$216.28	1
Nebraska	17	$1517.37	$1231.15	1
Alaska	14	$346.58	$221.82	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
52204Biopsy of bladder$415.75
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.