CPT 36216 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 Cardiovascular System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 36216 |
National average reimbursement for CPT 36216 by major payers:
$1,336.92
$1,551.65
$1,693.95
$1,725.88
| 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 36216 | ||||||
United | 36216 | $808.00 | 1962879932 - GUILFORD SURGERY CENTER LLC | 473071064 - (CT) GUILFORD SURGERY CENTER | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $98.00 | 1922068295 - ARKANSAS SURGERY AND ENDOSCOPY CENTER, INC, ASEC | 710781297 - (AR) ARKANSAS SURGERY AND ENDOSCOPY CENTER INC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $355.00 | 1821166521 - PHYSICIANS SURGERY CENTER LLC | 860936521 - (AZ) PHYSICIANS SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $303.00 | 1063453561 - TEMPLETON SURGERY CENTER, LLC, TEMPLETON SURGERY CENTER | 202246616 - (CA) TEMPLETON SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $145.00 | 1912627712 - CENTER FOR ROBOTIC SURGERY OF LOUISIANA LLC | 883537315 - CENTER FOR ROBOTIC SURGERY OF LOUISIANA LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $150.00 | 1104858513 - DOCTORS OUTPATIENT SURGERY CENTER LLC, SURGERY CENTER | 721341061 - (LA) DOCTORS OUTPATIENT SURGERY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $68.00 | 1588991228 - THE EYE SURGICAL CENTER OF FORT WAYNE, LLC | 271316595 - (IN) THE EYE SURGICAL CENTER OF FORT WAYNE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $117.00 | 1659679074 - EYE SURGERY CENTER OF MIDDLE TENNESSEE, LLC | 275124581 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $100.00 | 1609968478 - IOWA ENDOSCOPY CENTER, INC. | 421407285 - (IA) IOWA ENDOSCOPY CENTER INC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $100.00 | 1043204688 - INDIANA AMBULATORY SURGICAL ASSOCIATES, INC | 232923182 - (PA) INDIANA AMBULATORY SURGICAL ASSOCIATES INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $1020.00 | 1477516979 - FAIRFAX SURGICAL CENTER, L.P. | 621861640 - (VA) FAIRFAX SURGICAL CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $252.00 | 1891186987 - FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTER,LLC | 464426708 - (CO) FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTERLLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $1125.00 | 1902401748 - LANDMARK SURGICAL SUITES, LLC | 851130696 - (IN) LANDMARK SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $140.00 | 1306993464 - PACIFIC HILLS SURGERY CENTER LLC | 800180491 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36216 | $525.00 | 1649668781 - NORTHERN ARIZONA HEALTHCARE ORTHOPEDIC SURGERY CENTER, LLC | 472572645 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 36216 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36216 code is part of the Surgery services used for Surgical Procedures on the Cardiovascular 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 36216 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 |
|---|---|---|
| 36215-CPT | High | Selective Catheter Placement, Arterial System; Each First Order Thoracic Or Brachiocephalic Branch, Within A Vascular Family |
| 36216-CPT | High | Selective Catheter Placement, Arterial System; Initial Second Order Thoracic Or Brachiocephalic Branch, Within A Vascular Family |
| 36217-CPT | High | Selective Catheter Placement, Arterial System; Initial Third Order Or More Selective Thoracic Or Brachiocephalic Branch, Within A Vascular Family |
| 36218-CPT | Moderate | Selective Catheter Placement, Arterial System; Additional Second Order, Third Order, And Beyond, Thoracic Or Brachiocephalic Branch, Within A Vascular Family (List In Addition To Code For Initial Second Or Third Order Vessel As Appropriate) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 36216. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36216 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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