CPT 22513 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 22513 |
National average reimbursement for CPT 22513 by major payers:
$6,932.65
$9,325.24
$9,062.74
$9,889.37
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 22513 | ||||||
United | 22513 | $2500.00 | 1275708919 - WOMEN'S SURGICAL CENTER AT NORTHCARE, LLC | 261411936 - (CO) WOMEN S SURGICAL CENTER AT NOR | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $2700.00 | 1245393602 - MARYAM RAHBAR, MD, INC., PACIFIC COAST SPINE INSTITUTE AND PAIN CENTER | 205511930 - (CA) MARYAM RAHBAR MD INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $5043.00 | 1639498454 - NEW VISTA HEALTH, LLC, PINEY POINT SURGERY CENTER | 272416864 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $7810.00 | 1922234855 - EYE SURGERY CENTER OF GEORGIA, LLC | 262852432 - (GA) EYE SURGERY CENTER OF GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $16617.00 | 1124074273 - METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., L.L.P., METHODIST HOSPITAL | 742730328 | TX | General Acute Care Hospital (282N00000X) |
United | 22513 | $3763.00 | 1124324181 - MANHATTAN ENDOSCOPY CENTER LLC, MANHATTAN ENDO | 271510596 - (NY) MANHATTAN ENDOSCOPY CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $6492.00 | 1487716650 - CARONDELET ST. MARY'S NORTHWEST, LLC, CARONDELET FOOTHILLS SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $10278.20 | 1033168786 - HOUSTON VAMC | 760418077 | TX | General Acute Care Hospital (282N00000X) |
United | 22513 | $5500.00 | 1508400920 - NAZARETH ENDOSCOPY CENTER, LLC | 824072967 - (PA) NAZARETH ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $8169.00 | 1831629526 - EBD BEMC BURLESON, LLC, BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL GRAND PRAIRIE | 364755936 | TX | General Acute Care Hospital (282N00000X) |
United | 22513 | $3200.00 | 1740289024 - KOOTENAI OUTPATIENT SURGERY CNTR LLC, KOOTENAI OUTPATIENT SURGERY | 820523354 - (ID) KOOTENAI OUTPATIENT SURGERY | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $2202.00 | 1215025010 - RIVERWALK SURGERY CENTER, INC | 472075991 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $8169.00 | 1922002674 - FRISCO MEDICAL CENTER LLP, BAYLOR SCOTT & WHITE MED CNTR - FRISCO | 752865177 - (TX) FRISCO MEDICAL CENTER LLP | TX | General Acute Care Hospital (282N00000X) |
United | 22513 | $1943.00 | 1427662345 - BENTONVILLE AMBULATORY SURGERY CENTER, LLC | 832500684 - (AR) BENTONVILLE AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22513 | $8296.00 | 1609855139 - TEXAS HEART HOSPITAL OF THE SOUTHWEST, LLC, BAYLOR SCOTT & WHITE HEART AND VASCULAR HOSPITAL - DALLAS | 412101361 - (TX) TEXAS HEART HOSPITAL OF THE SOUTHWEST, L.L.P | TX | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 22513 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22513 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 22513 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 22510-CPT | High | Percutaneous Vertebral Augmentation Including Imaging Guidance If Applicable; 1 Vertebral Body. Unilateral Or Bilateral Injection Including Imaging Guidance- Cervicothoracic |
| 22511-CPT | High | Percutaneous Vertebral Augmentation Including Imaging Guidance If Applicable; 1 Vertebral Body. Unilateral Or Bilateral Injection Including Imaging Guidance- Lumbosacral |
| 22512-CPT | Moderate | Percutaneous Vertebroplasty (Bone Biopsy Included When Performed), 1 Vertebral Body, Unilateral Or Bilateral Injection, Inclusive Of All Imaging Guidance; Each Additional Cervicothoracic Or Lumbosacral Vertebral Body (List Separately In Addition To Code For Primary |
| 22513-CPT | High | Percutaneous Vertebral Augmentation Including Cavity Creation (Fracture Reduction And Bone Biopsy Included When Performed) Using Mechanical Device (Eg Kyphoplasty) 1 Vertebral Body Unilateral Or Bilateral Cannulation Inclusive Of All Imaging Guidance; Thoracic |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22513. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22513 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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