How much does Medicare pay for CPT 52240?

Medicare allowed an average of $789.42 per service and paid $625.69 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3293.78, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52240?

Destruction and/or removal of large growth of bladder using an endoscope. It was billed 3,714 times to 3,242 Medicare beneficiaries by 205 providers in 2024.

Does 52240 pay differently in an office than a hospital?

Yes. The allowed amount averaged $383.99 in an office setting and $798.12 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 52240 most?

Urology, with 2,874 services from 165 clinicians. Next are Ambulatory Surgical Center, General Surgery.

CPT 52240

Destruction and/or removal of large growth of bladder using an endoscope

$789.42Medicare-allowed amount per service, averaged across 3,714 services

Providers submitted

$3293.78

Asking price, not received

Medicare allowed

$789.42

The fee schedule figure

Medicare paid

$625.69

Balance is patient coinsurance

Providers submitted an average of $3293.78 for this code and Medicare allowed $789.42 — 4.2× 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 $625.69 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $383.99
Hospital / facility: $798.12

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 78 services were billed in an office setting and 3,636 in a facility.

Services: 3,714
Beneficiaries: 3,242
Providers billing it: 205
Total allowed: $2,931,906

What Medicare pays for CPT 52240

Across 3,714 services billed by 205 providers to 3,242 beneficiaries, Medicare allowed an average of $789.42 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 52240

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	2,874	2,490	$375.76	165
Ambulatory Surgical Center	788	706	$2324.11	39
General Surgery	52	46	$395.71	1

52240 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
California	455	$781.72	$561.06	25
New York	367	$490.64	$333.02	15
Florida	362	$924.89	$759.53	21
Maryland	252	$1344.66	$1076.75	12
Arizona	211	$772.27	$615.43	10
Texas	197	$822.52	$665.82	13
Indiana	185	$786.52	$638.56	11
New Jersey	183	$911.72	$683.20	9
Ohio	140	$636.19	$513.46	7
Pennsylvania	129	$722.14	$608.08	8
South Carolina	107	$739.40	$644.51	6
Tennessee	102	$1632.29	$1442.86	5
Nevada	77	$700.91	$569.87	4
Massachusetts	75	$396.20	$292.69	5
Oklahoma	75	$362.65	$282.72	4
Colorado	73	$1274.34	$1018.28	4
North Carolina	68	$931.13	$785.08	4
Oregon	64	$1022.61	$769.83	3
Illinois	60	$1050.88	$804.75	4
Virginia	54	$1171.56	$963.46	3
District of Columbia	50	$415.63	$293.43	3
New Hampshire	44	$378.22	$296.99	3
Rhode Island	43	$342.23	$269.20	2
Iowa	43	$355.26	$286.55	3
Mississippi	40	$949.04	$885.77	3
Michigan	36	$351.27	$273.27	3
Washington	31	$339.91	$266.02	2
West Virginia	25	$379.98	$294.21	1
Kansas	17	$366.56	$291.56	1
Wisconsin	17	$353.07	$300.85	1
Wyoming	15	$342.77	$300.44	1
Montana	15	$407.44	$301.10	1
South Dakota	14	$358.14	$290.66	1
Connecticut	14	$398.22	$248.40	1
Missouri	13	$350.49	$289.45	1
Arkansas	13	$348.56	$300.67	1
Kentucky	13	$385.67	$295.18	1
Georgia	12	$322.82	$250.57	1
Utah	12	$367.65	$284.11	1
Louisiana	11	$346.28	$274.02	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
52204Biopsy of bladder$415.75
52234Destruction and/or removal of growth of bladder and urethra$719.29
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.