How much does Medicare pay for CPT 52356?

Medicare allowed an average of $687.05 per service and paid $544.56 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3174.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52356?

Crushing of stone of ureter with insertion of stent using an endoscope. It was billed 73,370 times to 66,972 Medicare beneficiaries by 3,241 providers in 2024.

Does 52356 pay differently in an office than a hospital?

Yes. The allowed amount averaged $418.20 in an office setting and $688.98 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 52356 most?

Urology, with 62,187 services from 2,945 clinicians. Next are Ambulatory Surgical Center, General Surgery, Osteopathic Manipulative Medicine.

CPT 52356

Crushing of stone of ureter with insertion of stent using an endoscope

$687.05Medicare-allowed amount per service, averaged across 73,370 services

Providers submitted

$3174.17

Asking price, not received

Medicare allowed

$687.05

The fee schedule figure

Medicare paid

$544.56

Balance is patient coinsurance

Providers submitted an average of $3174.17 for this code and Medicare allowed $687.05 — 4.6× 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 $544.56 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $418.20
Hospital / facility: $688.98

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 523 services were billed in an office setting and 72,847 in a facility.

Services: 73,370
Beneficiaries: 66,972
Providers billing it: 3,241
Total allowed: $50,408,859

What Medicare pays for CPT 52356

Across 73,370 services billed by 3,241 providers to 66,972 beneficiaries, Medicare allowed an average of $687.05 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 52356

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	62,187	56,991	$404.61	2,945
Ambulatory Surgical Center	10,973	9,792	$2293.03	286
General Surgery	90	81	$423.26	5
Osteopathic Manipulative Medicine	38	36	$378.23	1
Thoracic Surgery	23	15	$412.65	1
Internal Medicine	22	22	$422.89	1
Family Practice	19	19	$409.22	1
Neurology	18	16	$402.25	1

52356 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
Florida	5,268	$666.27	$539.02	238
California	4,424	$802.93	$557.48	208
Pennsylvania	3,578	$585.24	$466.22	161
Texas	3,465	$756.99	$622.92	170
Illinois	3,310	$640.98	$509.45	147
Virginia	3,261	$821.90	$683.06	106
Ohio	3,216	$579.63	$474.86	138
Tennessee	3,003	$767.73	$672.40	113
New York	2,802	$637.53	$463.78	130
Maryland	2,755	$1185.96	$947.48	98
Indiana	2,480	$658.54	$546.28	108
Georgia	2,260	$660.92	$541.37	105
New Jersey	2,246	$823.90	$615.75	99
North Carolina	2,036	$586.14	$487.00	101
South Carolina	1,865	$635.41	$526.47	75
Massachusetts	1,799	$539.30	$410.62	82
Missouri	1,772	$713.88	$594.03	71
Michigan	1,665	$474.19	$374.64	81
Arizona	1,574	$686.07	$560.83	62
Washington	1,327	$694.58	$526.34	68
Iowa	1,271	$757.10	$663.11	50
Kansas	1,179	$655.12	$554.95	44
Kentucky	1,160	$530.15	$440.68	53
Wisconsin	1,142	$473.69	$397.27	60
Mississippi	1,129	$927.81	$864.59	30
Oregon	1,078	$844.70	$640.13	54
Colorado	1,050	$950.37	$759.27	51
Arkansas	957	$557.52	$479.28	37
Oklahoma	914	$382.06	$314.26	45
Minnesota	876	$653.78	$527.90	52
Alabama	773	$514.90	$450.87	41
Louisiana	694	$390.71	$319.41	36
Nebraska	694	$631.03	$542.58	34
Utah	675	$759.82	$632.27	31
Connecticut	643	$472.44	$346.36	34
Idaho	579	$778.82	$666.60	22
Nevada	566	$824.21	$673.91	24
New Hampshire	510	$413.00	$322.93	22
West Virginia	411	$401.75	$314.10	18
South Dakota	372	$393.20	$326.25	17
Montana	369	$477.94	$384.60	19
Delaware	365	$725.51	$575.27	17
Alaska	297	$1108.48	$725.20	14
New Mexico	280	$510.59	$404.09	11
North Dakota	221	$389.59	$319.95	10
District of Columbia	217	$453.87	$322.14	9
Maine	205	$409.32	$320.54	11
Vermont	178	$405.61	$331.54	9
Wyoming	169	$729.19	$590.86	8
Hawaii	154	$819.14	$651.59	9
Rhode Island	136	$398.10	$318.93	8

Related codes

52332Insertion of stent in ureter$224.05
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
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.