How much does Medicare pay for CPT 52315?

Medicare allowed an average of $464.15 per service and paid $366.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1796.07, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52315?

Complicated removal of foreign body, stone, or stent in urethra or bladder using an endoscope. It was billed 1,775 times to 1,700 Medicare beneficiaries by 70 providers in 2024.

Does 52315 pay differently in an office than a hospital?

Yes. The allowed amount averaged $480.03 in an office setting and $417.81 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 52315 most?

Urology, with 1,556 services from 61 clinicians. Next are Ambulatory Surgical Center, General Surgery, Physician Assistant.

CPT 52315

Complicated removal of foreign body, stone, or stent in urethra or bladder using an endoscope

$464.15Medicare-allowed amount per service, averaged across 1,775 services

Providers submitted

$1796.07

Asking price, not received

Medicare allowed

$464.15

The fee schedule figure

Medicare paid

$366.33

Balance is patient coinsurance

Providers submitted an average of $1796.07 for this code and Medicare allowed $464.15 — 3.9× 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 $366.33 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $480.03
Hospital / facility: $417.81

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,322 services were billed in an office setting and 453 in a facility.

Services: 1,775
Beneficiaries: 1,700
Providers billing it: 70
Total allowed: $823,866

What Medicare pays for CPT 52315

Across 1,775 services billed by 70 providers to 1,700 beneficiaries, Medicare allowed an average of $464.15 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 52315

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	1,556	1,484	$441.07	61
Ambulatory Surgical Center	119	119	$850.02	4
General Surgery	65	63	$367.42	4
Physician Assistant	35	34	$358.01	1

52315 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
New Jersey	407	$503.71	$362.67	12
New York	236	$505.55	$334.70	8
South Carolina	130	$450.64	$361.22	5
Maryland	119	$577.18	$500.90	2
California	105	$497.78	$344.55	6
Texas	97	$447.12	$358.23	5
Michigan	77	$299.75	$233.78	4
Ohio	66	$303.41	$253.10	2
Oklahoma	62	$424.23	$359.21	1
North Carolina	50	$341.57	$280.16	2
Florida	47	$487.76	$353.65	2
Utah	46	$368.76	$308.08	2
Nebraska	35	$690.68	$566.20	2
Mississippi	35	$410.86	$357.85	1
Alabama	33	$252.47	$210.92	2
Tennessee	30	$609.78	$523.30	2
Hawaii	27	$642.91	$479.50	2
Massachusetts	23	$475.27	$366.68	1
Kentucky	23	$409.88	$362.48	1
Virginia	22	$421.39	$362.94	1
Illinois	21	$508.98	$370.61	1
Oregon	20	$254.78	$215.29	1
Georgia	16	$392.55	$267.42	1
Pennsylvania	14	$276.74	$195.61	1
Louisiana	12	$160.02	$114.07	1
Washington	11	$481.35	$374.71	1
Arizona	11	$450.04	$366.37	1

Related codes

52332Insertion of stent in ureter$224.05
52356Crushing of stone of ureter$687.05
52310Simple removal of foreign body$344.09
52352Removal or manipulation of stone in ureter or kidney$408.05
52351Diagnostic exam of bladder$704.52
52353Crushing of stone of ureter$739.44
52317Crushing, fragmenting, and removal of bladder stones, less than 2.5 cm$838.39

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.