How much does Medicare pay for CPT 52649?

Medicare allowed an average of $829.19 per service and paid $654.99 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3949.32, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 52649?

Complete laser fragmentation of prostate including control of bleeding using an endoscope. It was billed 8,706 times to 8,678 Medicare beneficiaries by 251 providers in 2024.

Does 52649 pay differently in an office than a hospital?

Yes. The allowed amount averaged $792.20 in an office setting and $830.17 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 52649 most?

Urology, with 8,584 services from 244 clinicians. Next are Ambulatory Surgical Center.

CPT 52649

Complete laser fragmentation of prostate including control of bleeding using an endoscope

$829.19Medicare-allowed amount per service, averaged across 8,706 services

Providers submitted

$3949.32

Asking price, not received

Medicare allowed

$829.19

The fee schedule figure

Medicare paid

$654.99

Balance is patient coinsurance

Providers submitted an average of $3949.32 for this code and Medicare allowed $829.19 — 4.8× 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 $654.99 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $792.20
Hospital / facility: $830.17

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 225 services were billed in an office setting and 8,481 in a facility.

Services: 8,706
Beneficiaries: 8,678
Providers billing it: 251
Total allowed: $7,218,928

What Medicare pays for CPT 52649

Across 8,706 services billed by 251 providers to 8,678 beneficiaries, Medicare allowed an average of $829.19 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 52649

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	8,584	8,556	$804.80	244
Ambulatory Surgical Center	122	122	$2545.48	7

52649 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
Indiana	703	$749.70	$635.51	17
California	646	$972.05	$693.50	21
Florida	615	$812.32	$621.44	16
Texas	602	$911.16	$731.55	21
Illinois	504	$857.60	$639.02	9
Arizona	490	$832.62	$669.88	10
Wisconsin	451	$759.82	$634.52	14
Virginia	377	$792.30	$635.23	12
Tennessee	356	$816.27	$674.68	9
Ohio	349	$890.01	$711.86	11
New York	312	$869.81	$639.19	12
North Carolina	274	$769.83	$632.06	7
Michigan	273	$809.01	$631.75	10
Massachusetts	267	$872.75	$630.82	8
Minnesota	260	$783.92	$631.55	7
Pennsylvania	250	$827.03	$628.53	9
South Carolina	186	$687.88	$550.27	3
Colorado	175	$813.96	$630.95	7
Alabama	156	$838.53	$630.96	3
Connecticut	142	$850.07	$632.94	4
Montana	110	$817.57	$636.22	3
Missouri	107	$789.78	$628.84	5
Oklahoma	101	$763.42	$634.42	3
Georgia	91	$801.13	$637.19	2
Maryland	90	$852.13	$634.49	1
Idaho	78	$745.30	$626.55	2
District of Columbia	76	$918.45	$630.10	2
Delaware	75	$879.40	$638.30	1
New Mexico	75	$784.52	$634.45	2
Washington	65	$781.47	$623.20	3
New Jersey	62	$885.99	$634.10	3
North Dakota	58	$772.58	$631.15	2
Maine	54	$797.44	$625.40	2
Kentucky	49	$813.63	$625.44	1
South Dakota	40	$769.31	$638.24	1
Utah	39	$776.58	$628.50	2
Rhode Island	30	$816.47	$641.64	1
New Hampshire	29	$779.29	$622.03	1
Oregon	27	$814.07	$630.23	1
Nebraska	23	$705.75	$640.30	1
Kansas	21	$752.90	$641.04	1
West Virginia	18	$827.10	$643.04	1

Related codes

52601Removal of prostate gland$977.95
52648Complete laser vaporization of prostate including control of bleeding$1041.49

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.