How much does Medicare pay for CPT 52351?

Medicare allowed an average of $704.52 per service and paid $559.03 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2528.00, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52351?

Diagnostic exam of bladder, urethra, and ureter or kidney using an endoscope. It was billed 4,353 times to 3,974 Medicare beneficiaries by 223 providers in 2024.

Does 52351 pay differently in an office than a hospital?

Yes. The allowed amount averaged $274.03 in an office setting and $705.61 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 52351 most?

Urology, with 2,745 services from 157 clinicians. Next are Ambulatory Surgical Center, Internal Medicine.

CPT 52351

Diagnostic exam of bladder, urethra, and ureter or kidney using an endoscope

$704.52Medicare-allowed amount per service, averaged across 4,353 services

Providers submitted

$2528.00

Asking price, not received

Medicare allowed

$704.52

The fee schedule figure

Medicare paid

$559.03

Balance is patient coinsurance

Providers submitted an average of $2528.00 for this code and Medicare allowed $704.52 — 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 $559.03 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $274.03
Hospital / facility: $705.61

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 11 services were billed in an office setting and 4,342 in a facility.

Services: 4,353
Beneficiaries: 3,974
Providers billing it: 223
Total allowed: $3,066,776

What Medicare pays for CPT 52351

Across 4,353 services billed by 223 providers to 3,974 beneficiaries, Medicare allowed an average of $704.52 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 52351

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	2,745	2,475	$257.18	157
Ambulatory Surgical Center	1,595	1,486	$1478.75	65
Internal Medicine	13	13	$169.52	1

52351 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
Tennessee	397	$950.89	$834.29	11
Maryland	332	$1096.19	$892.12	17
Illinois	304	$377.70	$282.43	14
Florida	291	$752.93	$633.37	19
Virginia	271	$864.59	$721.58	9
Mississippi	245	$746.34	$682.11	12
Ohio	237	$680.69	$557.85	10
South Carolina	235	$380.45	$324.03	9
Indiana	208	$412.36	$343.33	13
New Jersey	188	$854.89	$639.68	7
New York	171	$594.06	$427.79	10
Pennsylvania	130	$502.41	$401.07	7
Kentucky	121	$420.93	$343.08	8
Texas	119	$889.95	$746.79	6
Georgia	106	$1347.75	$1075.86	6
California	101	$446.78	$311.45	7
Arkansas	96	$238.70	$204.80	7
Missouri	94	$1103.20	$975.52	5
Michigan	86	$279.78	$207.18	6
Arizona	82	$691.10	$565.90	6
Iowa	75	$844.95	$753.48	4
Kansas	74	$432.83	$386.22	5
Washington	60	$807.94	$625.33	5
North Carolina	44	$269.70	$213.95	2
Massachusetts	43	$824.90	$660.55	3
Oklahoma	40	$711.14	$622.02	3
Minnesota	39	$231.24	$187.94	3
District of Columbia	37	$185.07	$123.20	1
Oregon	36	$1700.87	$1257.04	2
Nevada	18	$1441.46	$1203.93	1
West Virginia	17	$275.45	$203.98	1
Idaho	15	$1332.81	$1210.99	1
Alabama	14	$264.27	$224.18	1
Wisconsin	14	$244.00	$207.94	1
South Dakota	13	$266.55	$206.24	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
52353Crushing of stone of ureter$739.44
52317Crushing, fragmenting, and removal of bladder stones, less than 2.5 cm$838.39
52315Complicated removal of foreign body$464.15

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.