CPT 39561 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 Mediastinum and Diaphragm |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 39561 |
National average reimbursement for CPT 39561 by major payers:
$1,598.73
$1,618.11
$1,658.60
$2,042.79
| 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 39561 | ||||||
United | 39561 | $380.00 | 1215028469 - DEL VAL ASC LLC, THE EYE SURGERY CENTER | 760788813 - (PA) DEL VAL ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $2746.00 | 1215990627 - WESTSIDE SURGERY CENTER LLC, WESTSIDE SURGERY CENTER LTD | 593026856 - (FL) WESTSIDE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $307.00 | 1659340404 - LITTLE ROCK SURGERY CENTER, LLC | 203687986 - (AR) LITTLE ROCK SURGERY CENTER | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $734.00 | 1366013914 - THE LASER SURGERY CENTER, LLC | 861190282 - (TX) THE LASER SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $1374.00 | 1528553559 - SURGICAL PAIN CENTER OF THE ADIRONDACKS, LLC | 821943675 - (NY) SURGICAL PAIN CENTER OF THE ADIRONDACKS LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $1042.00 | 1801944343 - HUDSON VALLEY AMBULATORY SURGERY, LLC | 510451539 - (NY) HUDSON VALLEY AMBULATORY | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $983.00 | 1548241623 - GASTROENTEROLOGY ASSOCIATES, LLC, GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER | 912104493 - (WA) GASTROENTEROLOGY ASSOCIATES PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $535.00 | 1023373628 - EYES ON STARK SURGERY CENTER, LLC, VISTA SURGICAL CENTER | 451114025 - (OH) EYES ON STARK SURGERY CENTER, LLC DBA VISTA SURGICAL CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $840.00 | 1336445873 - SAND LAKE SURGICENTER LLC, SAND LAKE SURGERY CENTER | 273787593 - (FL) SAND LAKE SURGICENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $422.00 | 1689657058 - CENTER FOR ADVANCED EYE SURGERY, LTD | 341866635 - (OH) CENTER FOR ADVANCED EYE SURGERY LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $2737.00 | 1295213734 - LOS GATOS SURGICAL CENTER, A CALIFORNIA LIMITED PARTNERSHIP, ENDOSCOPY CENTER OF SILICON VALLEY | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $695.00 | 1104833839 - ROCHESTER SURGERY CENTER, P.C. | 200510602 - (MI) ROCHESTER SURGERY CENTER PC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $2164.00 | 1568776615 - CEDAR PARK SURGERY CENTER, LLC | 272533497 - (TX) CEDAR PARK SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $3931.00 | 1417922915 - FRANCONIA-SPRINGFIELD SURGERY CENTER, LLC, INOVA SURGERY CENTER @ FRANCONIA-SPRINGFIELD | 542018390 - (VA) INOVA AMBULATORY SURGICAL CENTERS | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 39561 | $658.00 | 1447271713 - COLUMBUS ORTHOPEDIC OUTPATIENT | 900069344 - (MS) COLUMBUS ORTHOPEDIC OUTPATIENT | MS | 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 39561 vs. Other Surgical Procedures on the Mediastinum and Diaphragm Codes
The CPT 39561 code is part of the Surgery services used for Surgical Procedures on the Mediastinum and Diaphragm. 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 39561 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 |
|---|---|---|
| 39503-CPT | High | Repair, Neonatal Diaphragmatic Hernia, With Or Without Chest Tube Insertion And With Or Without Creation Of Ventral Hernia |
| 39540-CPT | High | Rep.Diaphragmat.Hernia,Traum;Acute |
| 39541-CPT | High | Repair, Diaphragmatic Hernia,Traumatic;C |
| 39561-CPT | High | Resection, Diaphragm; With Complex Repair (Eg, Prosthetic Material, Local Muscle Flap) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 39561. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 39561 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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