CPT 36516 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • GC - Service performed by resident under supervision • AG - Primary physician |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 36516 |
National average reimbursement for CPT 36516 by major payers:
$2,266.13
$2,752.61
$2,748.86
$3,123.58
| 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 36516 | ||||||
United | 36516 | $2350.00 | 1194966051 - FIRST STREET SURGERY CENTER INC. | 263375664 - (CA) FIRST STREET SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $1185.00 | 1154412757 - SURGICENTER LTD, BLOOMBERG EYE CENTER | 311585329 - (OH) SURGICENTER LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $2341.00 | 1942261599 - SDOSC, LP, SAN DIEGO OUTPATIENT AMBULATORY SURGICAL CENTER | 30506487 - (CA) SDOSC, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $2693.00 | 1053560896 - ASC DEVELOPMENT COMPANY, LLC, NATIONAL SPINE AND PAIN CENTERS | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $3340.00 | 1164513149 - ENDO-SURGI OF UNION ASC LLC | 223248249 - (NJ) ENDO-SURGI CENTER, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $3268.00 | 1689699597 - NAPA SURGERY CENTER LLC | 680366295 - (CA) NAPA SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $1570.00 | 1255404398 - WARMINSTER AMBULATORY SURGICAL, BUXMONT AMBULATORY SURGICAL CENTER | 232779763 - (PA) WARMINSTER AMBULATORY SURGICAL | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $5433.00 | 1093086183 - CHANDLER ENDOSCOPY AMBULATORY SURGERY CENTER, LLC, CHANDLER ENDOSCOPY CENTER | 454307241 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $1680.00 | 1609376409 - KOKOMO AMBULATORY SURGERY CENTER | 823461246 - (IN) KOKOMO AMBULATORY SURGERY CENTER | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $2931.00 | 1144370594 - THIRD STREET SURGERY CENTER LLC, THIRD STREET SURGERY CENTER LP | 841663840 - (CA) THIRD STREET SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $390.00 | 1023134640 - LOCUST GROVE ENDO CENTER | 205860757 - (GA) LOCUST GROVE ENDO CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $865.00 | 1306892609 - THE CLEARWATER ORTHOPAEDIC ASC LLC, C MED AMBULATORY SURGERY CENTER | 331011433 - (FL) THE CLEARWATER ORTHOPAEDIC ASS | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $1583.52 | 1366877433 - LISA VELLINGA | 350593390 - DEACONESS HOSPITAL INC | NV | Certified Registered Nurse Anesthetist (367500000X) |
United | 36516 | $5020.00 | 1902807159 - SURGERY CENTER OF SCOTTSDALE, LLC, MOUNTAIN VIEW SURGERY CENTER OF SCOTTSDALE | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36516 | $1501.00 | 1336170596 - THE UROLOGIC SURGICAL CENTER LLC | 562354405 - (PA) THE UROLOGIC SURGICAL CENTER LLC | PA | 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 36516 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36516 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 36516 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 |
|---|---|---|
| 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 |
| 36516-CPT | High | Therapeutic Apheresis; With Extracorporeal Immunoadsorption Selective Adsorption Or Selectivefiltration And Plasma Reinfusion (Desc Revised 1/1/2018) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 36516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36516 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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