How much does Medicare pay for CPT 52601?

Medicare allowed an average of $977.95 per service and paid $775.01 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3668.13, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52601?

Removal of prostate gland using an electrocautery knife through urethra with control of bleeding using an endoscope. It was billed 19,006 times to 18,976 Medicare beneficiaries by 1,049 providers in 2024.

Does 52601 pay differently in an office than a hospital?

Yes. The allowed amount averaged $731.04 in an office setting and $979.45 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 52601 most?

Urology, with 15,817 services from 924 clinicians. Next are Ambulatory Surgical Center, Osteopathic Manipulative Medicine, General Surgery.

CPT 52601

Removal of prostate gland using an electrocautery knife through urethra with control of bleeding using an endoscope

$977.95Medicare-allowed amount per service, averaged across 19,006 services

Providers submitted

$3668.13

Asking price, not received

Medicare allowed

$977.95

The fee schedule figure

Medicare paid

$775.01

Balance is patient coinsurance

Providers submitted an average of $3668.13 for this code and Medicare allowed $977.95 — 3.8× 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 $775.01 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $731.04
Hospital / facility: $979.45

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 115 services were billed in an office setting and 18,891 in a facility.

Services: 19,006
Beneficiaries: 18,976
Providers billing it: 1,049
Total allowed: $18,586,918

What Medicare pays for CPT 52601

Across 19,006 services billed by 1,049 providers to 18,976 beneficiaries, Medicare allowed an average of $977.95 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 52601

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	15,817	15,804	$708.97	924
Ambulatory Surgical Center	3,097	3,080	$2359.88	120
Osteopathic Manipulative Medicine	40	40	$651.09	1
General Surgery	39	39	$747.23	3
Thoracic Surgery	13	13	$720.74	1

52601 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	2,033	$1035.43	$835.26	99
California	1,828	$978.55	$714.19	100
Texas	1,333	$961.12	$780.40	75
Arizona	881	$1169.53	$947.31	45
Maryland	835	$1576.35	$1259.05	38
South Carolina	737	$720.77	$581.03	39
Illinois	653	$958.32	$740.09	42
Tennessee	641	$1028.80	$891.51	32
New York	560	$942.86	$673.18	33
Utah	546	$895.17	$735.41	25
Mississippi	521	$999.38	$888.22	25
Washington	462	$899.27	$686.61	26
Ohio	456	$938.83	$756.34	26
Georgia	453	$1021.62	$814.41	27
Colorado	449	$1336.68	$1064.32	26
Pennsylvania	441	$860.90	$681.93	28
North Carolina	425	$723.56	$603.24	27
Nevada	415	$1196.39	$966.03	18
New Jersey	360	$1027.80	$778.47	18
Missouri	356	$934.01	$766.27	21
Kansas	342	$753.69	$639.44	17
Michigan	326	$826.95	$663.06	18
Oregon	321	$1106.77	$853.25	16
Massachusetts	319	$946.93	$708.67	21
Indiana	303	$845.58	$710.00	22
Iowa	291	$727.88	$623.60	19
Virginia	287	$978.53	$814.81	16
Arkansas	255	$643.76	$562.51	17
Oklahoma	239	$784.20	$665.39	16
Idaho	223	$1052.49	$899.16	11
Louisiana	207	$889.56	$742.58	12
Nebraska	196	$757.35	$659.30	12
Wisconsin	172	$672.41	$555.59	11
Minnesota	155	$894.27	$708.06	6
Kentucky	131	$688.19	$557.99	9
Montana	109	$980.62	$784.63	7
New Mexico	102	$953.73	$790.69	6
South Dakota	81	$671.46	$554.10	6
Alabama	80	$1121.57	$989.99	6
New Hampshire	73	$722.57	$551.23	5
West Virginia	64	$712.20	$553.21	4
Alaska	62	$880.62	$559.40	3
Wyoming	58	$1002.69	$821.97	5
Connecticut	49	$692.09	$534.73	3
Delaware	42	$727.82	$561.95	2
Hawaii	38	$715.54	$562.76	3
District of Columbia	33	$797.72	$564.00	2
North Dakota	30	$686.68	$560.20	2
Guam	20	$744.36	$558.72	1
ZZ	13	$691.48	$565.67	1

Related codes

52648Complete laser vaporization of prostate including control of bleeding$1041.49
52649Complete laser fragmentation of prostate including control of bleeding$829.19

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.