CPT 36415 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 11 - Office • 81 - Independent Laboratory |
| Common Modifiers | • None • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 36415 by major payers:
$5.77
$2.91
$5.78
$4.08
| 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 36415 | ||||||
United | 36415 | $9.42 | 1689883449 - BABAK GIVI | 300937486 | NY | Otolaryngology Physician (207Y00000X) |
United | 36415 | $10.14 | 1184731135 - STEPHEN FORMAN | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Hematology (Internal Medicine) Physician (207RH0000X) |
United | 36415 | $8.71 | 1952597858 - VANESSA SALINAS-LUNA | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | 36415 | $8.71 | 1396150736 - RUSHA BHANDARI | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | 36415 | $8.76 | 1922329093 - MICHAEL STARC | 300937486 | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 36415 | $11.31 | 1689883449 - BABAK GIVI | 300937486 | NY | Otolaryngology Physician (207Y00000X) |
United | 36415 | $8.71 | 1902197254 - MARI BOZOGHLANIAN | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Diagnostic Radiology Physician (2085R0202X) |
United | 36415 | $4.00 | 1922626167 - ILEANA IZQUIERDO | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Certified Registered Nurse Anesthetist (367500000X) |
United | 36415 | $11.43 | 1689883449 - BABAK GIVI | 300937486 | NY | Otolaryngology Physician (207Y00000X) |
United | 36415 | $9.42 | 1932184876 - BERNARD PARK | 300937486 | NY | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician (208G00000X) |
United | 36415 | $4.00 | 1033368642 - FINLY ZACHARIAH | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Hospice and Palliative Medicine (Family Medicine) Physician (207QH0002X) |
United | 36415 | $4.00 | 1265642110 - KIMHUYNH NGUYEN | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Family Nurse Practitioner (363LF0000X) |
United | 36415 | $4.00 | 1154579290 - CARMEN SEDGEMAN | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Nurse Practitioner (363L00000X) |
United | 36415 | $4.00 | 1548387525 - THOMAS GERNON | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Otolaryngology Physician (207Y00000X) |
United | 36415 | $8.76 | 1689883449 - BABAK GIVI | 300937486 | NY | Otolaryngology Physician (207Y00000X) |
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 36415 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36415 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 36415 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 |
|---|---|---|
| 36400-CPT | Low | Venipuncture Younger Than Age 3 Years Necessi- Tating The Skill Of A Physician Or Other Qualifiedhealth Care Professional Not To Be Used For Routine Venipuncture; Femoral Or Jugular Vein (Revised 1/1/2013) |
| 36405-CPT | Low | Venipuncture Younger Than Age 3 Years Necessi Tating The Skill Of A Physician Or Other Qualified Health Care Professional Not To Be Usedfor Routine Venipuncture; Scalp Vein (Revised 1/1/2013) |
| 36406-CPT | Low | Venipuncture Younger Than Age 3 Years Necessi- Tating The Skill Of A Physician Or Other Qualifiedhealth Care Professional Not To Be Used For For Routine Venipuncture; Other Vein (Rvsd 1/1/13) |
| 36415-CPT | Low | Routine Venipuncture/Finger/Heel/Ear Stick, Collection, Specimen(S) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 36415. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36415 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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