How much does Medicare pay for CPT 52281?

Medicare allowed an average of $396.69 per service and paid $309.11 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1432.80, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52281?

Dilation of urethra using an endoscope. It was billed 25,417 times to 22,204 Medicare beneficiaries by 634 providers in 2024.

Does 52281 pay differently in an office than a hospital?

Yes. The allowed amount averaged $330.22 in an office setting and $501.00 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 52281 most?

Urology, with 18,661 services from 492 clinicians. Next are Ambulatory Surgical Center, Obstetrics & Gynecology, Undefined Physician type.

CPT 52281

Dilation of urethra using an endoscope

$396.69Medicare-allowed amount per service, averaged across 25,417 services

Providers submitted

$1432.80

Asking price, not received

Medicare allowed

$396.69

The fee schedule figure

Medicare paid

$309.11

Balance is patient coinsurance

Providers submitted an average of $1432.80 for this code and Medicare allowed $396.69 — 3.6× 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 $309.11 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $330.22
Hospital / facility: $501.00

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 15,525 services were billed in an office setting and 9,892 in a facility.

Services: 25,417
Beneficiaries: 22,204
Providers billing it: 634
Total allowed: $10,082,670

What Medicare pays for CPT 52281

Across 25,417 services billed by 634 providers to 22,204 beneficiaries, Medicare allowed an average of $396.69 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 52281

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	18,661	15,904	$284.94	492
Ambulatory Surgical Center	4,793	4,374	$885.97	112
Obstetrics & Gynecology	1,461	1,424	$234.92	26
Undefined Physician type	491	491	$351.73	3
Physician Assistant	11	11	$283.05	1

52281 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	6,068	$394.80	$280.63	93
Florida	3,433	$396.83	$310.94	89
New Jersey	2,070	$418.11	$294.63	58
New York	1,773	$387.55	$270.49	44
Illinois	1,421	$263.34	$202.68	31
Ohio	1,138	$367.24	$300.57	33
Mississippi	1,051	$440.38	$409.13	13
Georgia	982	$447.36	$364.97	24
Maryland	814	$569.23	$451.34	29
Arizona	753	$418.46	$333.41	22
Louisiana	684	$334.22	$288.78	13
South Carolina	512	$350.92	$291.04	16
Texas	490	$350.04	$277.51	18
Massachusetts	451	$356.16	$248.10	13
Michigan	450	$327.40	$252.75	12
Pennsylvania	391	$563.22	$442.24	12
Tennessee	334	$513.84	$441.28	11
Oklahoma	299	$222.14	$187.13	9
Colorado	235	$542.34	$434.80	5
Kentucky	197	$374.66	$313.92	6
Virginia	196	$501.28	$408.24	6
Arkansas	188	$488.46	$418.51	7
Alabama	180	$295.79	$256.43	4
Nevada	166	$359.34	$281.81	6
Washington	149	$488.01	$347.79	8
Indiana	116	$296.39	$235.30	7
Missouri	99	$298.90	$259.75	5
Nebraska	97	$731.30	$589.27	4
Kansas	93	$514.56	$440.38	4
North Carolina	93	$254.88	$211.04	6
Delaware	78	$415.68	$315.67	5
Hawaii	58	$313.54	$247.01	1
Connecticut	54	$333.36	$243.64	3
Montana	51	$226.63	$164.66	3
South Dakota	36	$826.37	$721.56	1
West Virginia	35	$191.92	$165.22	1
Oregon	35	$718.09	$512.45	2
Wisconsin	34	$144.14	$110.74	2
Utah	27	$221.98	$181.30	2
Iowa	26	$137.20	$109.63	2
U.S. Virgin Islands	22	$317.79	$231.42	1
District of Columbia	14	$127.11	$68.47	1
North Dakota	13	$136.92	$110.53	1
Minnesota	11	$283.05	$216.20	1

Related codes

52287Exam with injections of chemical for destruction of bladder using an e$382.62
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
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.