How much does Medicare pay for CPT 52353?

Medicare allowed an average of $739.44 per service and paid $587.37 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3074.87, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52353?

Crushing of stone of ureter using an endoscope. It was billed 2,910 times to 2,740 Medicare beneficiaries by 154 providers in 2024.

Does 52353 pay differently in an office than a hospital?

Yes. The allowed amount averaged $358.96 in an office setting and $748.00 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 52353 most?

Urology, with 2,256 services from 128 clinicians. Next are Ambulatory Surgical Center, Osteopathic Manipulative Medicine.

CPT 52353

Crushing of stone of ureter using an endoscope

$739.44Medicare-allowed amount per service, averaged across 2,910 services

Providers submitted

$3074.87

Asking price, not received

Medicare allowed

$739.44

The fee schedule figure

Medicare paid

$587.37

Balance is patient coinsurance

Providers submitted an average of $3074.87 for this code and Medicare allowed $739.44 — 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 $587.37 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $358.96
Hospital / facility: $748.00

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 64 services were billed in an office setting and 2,846 in a facility.

Services: 2,910
Beneficiaries: 2,740
Providers billing it: 154
Total allowed: $2,151,770

What Medicare pays for CPT 52353

Across 2,910 services billed by 154 providers to 2,740 beneficiaries, Medicare allowed an average of $739.44 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 52353

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	2,256	2,131	$346.02	128
Ambulatory Surgical Center	639	594	$2138.84	25
Osteopathic Manipulative Medicine	15	15	$296.31	1

52353 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	289	$1223.73	$1091.22	12
Michigan	211	$511.68	$410.57	11
Mississippi	209	$995.27	$891.95	10
Florida	207	$846.11	$703.90	11
Maryland	205	$988.80	$848.91	7
South Carolina	149	$719.86	$598.13	8
California	130	$984.35	$593.93	7
New Jersey	127	$616.12	$445.24	8
Massachusetts	114	$378.23	$279.41	7
Missouri	111	$970.16	$893.35	4
Pennsylvania	105	$371.94	$293.36	6
Texas	98	$469.33	$376.88	6
Indiana	92	$272.81	$218.63	6
Ohio	87	$708.45	$628.03	6
Nevada	84	$990.20	$824.15	4
New York	76	$382.70	$265.11	5
Virginia	72	$1543.60	$1294.18	4
Illinois	67	$372.39	$287.23	4
Kansas	48	$902.19	$776.99	3
Arkansas	48	$1233.52	$1050.67	3
Oklahoma	47	$366.50	$310.05	2
Arizona	37	$337.04	$272.54	2
District of Columbia	35	$107.13	$50.28	1
Georgia	32	$262.53	$203.91	2
Delaware	30	$368.66	$288.25	1
Oregon	29	$358.25	$276.26	2
Louisiana	27	$321.90	$288.63	2
Wisconsin	20	$324.93	$290.59	1
Connecticut	19	$91.67	$33.97	1
North Carolina	16	$383.69	$300.55	1
Washington	15	$327.86	$221.51	1
Idaho	15	$296.31	$231.15	1
Kentucky	13	$378.83	$303.91	1
New Hampshire	13	$343.89	$310.15	1
Colorado	11	$345.60	$273.78	1
West Virginia	11	$360.89	$274.43	1
South Dakota	11	$407.16	$335.08	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
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.