CPT 36513 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 36513 |
National average reimbursement for CPT 36513 by major payers:
$139.34
$142.41
$154.89
$174.06
| 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 36513 | ||||||
United | 36513 | $100.00 | 1376592204 - PALMETTO ENDOSCOPY CENTER LLC | 571195554 - (SC) PALMETTO ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $150.00 | 1033195912 - SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC, AVERA ENDOSCOPY/SURGICAL CENTER | 460461429 - (SD) SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $418.00 | 1114312659 - UNITED SHOCKWAVE SERVICES, LTD., UNITED THERAPIES | 363415474 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $150.00 | 1497206890 - MIDWEST EYE CONSULTANTS OHIO, INC., CATARACT & LASER INSTITUTE ASC - MAUMEE #352 | 300888250 - (OH) MIDWEST EYE CONSULTANTS OHIO INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $350.00 | 1528219474 - CLARKSTON ASC PARTNERS LLC, CLARKSTON SURGERY CENTER | 203360827 - (MI) CLARKSTON ASC PARTNERS, LLC DBA CLARKSTON SURGERY CENTER | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $124.00 | 1225665292 - ANNAPOLIS ENDOSCOPY CENTER LLC | 843556524 - (MD) ANNAPOLIS ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $150.00 | 1255510525 - EYE SURGERY CENTER OF MICHIGAN LLC | 205795977 - (MI) EYE SURGERY CENTER OF MICHIGAN | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $150.00 | 1194255372 - DECATUR UROLOGY SURGERY CENTER | 814721108 - (GA) DECATUR UROLOGY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $128.00 | 1962070896 - OAK ASC, LLC | 833101804 - (IL) OAK ASC LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $125.00 | 1245288257 - SURGICAL CENTER OF GREENSBORO, LLC | 631251243 - (NC) SURGICAL CENTER OF GREENSBORO LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $560.00 | 1750838801 - MEMORIAL HOUSTON SURGERY CENTER, LLC, MEMORIAL HOUSTON SURGERY CENTER | 371782795 - (TX) MEMORIAL HOUSTON SURGERY CENTER, | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $110.00 | 1457379364 - JONESBORO SURGERY CENTER, LLC | 731589472 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $100.00 | 1457350449 - BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER OF NORTH MS, LP, OXFORD SURGERY CENTER | 640925692 - (MS) BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER OF NORTH MS LP | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $304.00 | 1508912262 - WAUKEGAN ILLINOIS HOSPITAL COMPANY LLC, VISTA SURGERY CENTER | 203978521 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36513 | $68.00 | 1306079330 - WHITEWATER SURGERY CENTER LLC, WHITEWATER SURGERY CENTER | 264540954 - (IN) WHITEWATER SURGERY CENTER LLC | IN | 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 36513 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36513 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 36513 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 |
|---|---|---|
| 36456-CPT | Low | Partial Exchange Transfusion Blood Plasma Or Crystalloid Necessitating The Skill Of A Physician Or Other Qualified Health Care Professional Newborn |
| 36511-CPT | Low | Therapeutic Apheresis; For White Blood Cells |
| 36512-CPT | Low | Therapeutic Apheresis; For Red Blood Cells |
| 36513-CPT | Low | Therapeutic Apheresis; For Platelets |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 36513. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36513 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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