CPT 61250 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 Nervous System |
| Common Place of Service | • 21 - Inpatient Hospital • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | High |
National average reimbursement for CPT 61250 by major payers:
$1,204.36
$1,166.25
$1,184.34
$1,422.08
| 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 61250 | ||||||
United | 61250 | $362.00 | 1629181136 - JOON Y. KIM, MD, PC, CLAYTON CATARACT & LASER SURGERY CENTER | 581603174 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $1842.00 | 1720543481 - SURGICAL SUITES OF COASTAL VIRGINIA, LLC | 833205375 - (VA) SURGICAL SUITES OF COASTAL VIRGINIA LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $63.00 | 1114491073 - ASC DEVELOPMENT COMPANY LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $122.00 | 1225140510 - NORTHEAST AMBULATORY CENTER INC | 43382778 - (MA) NORTHEAST AMBULATORY CENTER, INC. | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $1124.00 | 1154088490 - BSC 3 LLC, BANNER SURGERY CENTER - SPORTS MEDICINE | 871712552 - (AZ) BSC 3 LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $300.00 | 1477633071 - SURGERY CENTER OF EYE SPECIALISTS OF INDIANA, PC, SURGERY CENTER | 351938206 - (IN) SURGERY CENTER OF EYE SPECIALISTS OF INDIANA PC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $595.00 | 1730130246 - PENNSYLVANIA EYE SURGERY CENTER, INC., MEMORIAL EYE INSTITUTE | 232262909 - (PA) PENNSYLVANIA EYE SURGERY CENTER, INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $17689.00 | 1821614710 - BAYCARE AURORA KAUKAUNA SURGERY CENTER LLC, KAUKAUNA SURGERY CENTER | 851420464 - (WI) BAYCARE AURORA KAUKAUNA SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $1049.00 | 1427003052 - EYE SURGERY CENTER OF NASHVILLE LLC | 621872622 - (TN) EYE SURGERY CENTER OF NASHVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $650.00 | 1508810656 - RETINAL AMBULATORY SURGERY CENTER OF NEW YORK, INC. | 134189700 - (NY) RETINAL AMBULATORY SURGERY CENTER OF NY, INC. | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $817.00 | 1083711568 - NATRAJ SURGERY CENTER INC. | 201290128 - (CA) NATRAJ SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $1167.00 | 1295163715 - BLUFFTON OKATIE SURGERY CENTER, L.L.C. | 364730753 | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $2785.00 | 1639804248 - WILLIS SURGICENTER, LLC | 842342776 - (TX) WILLIS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $4225.00 | 1609056290 - UCSD AMBULATORY SURGERY CENTER, LLC, UNIVERSITY AMBULATORY SURGERY CENTER | 261232189 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61250 | $1064.00 | 1144954165 - ADVANCED SURGICAL CARE OF LUTZ, LLC, ADVANCED SURGICAL CARE OF NEW TAMPA | 871390521 - (FL) ADVANCED SURGICAL CARE OF LUTZ LLC | FL | 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 61250 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61250 code is part of the Surgery services used for Surgical Procedures on the Nervous 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 61250 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 |
|---|---|---|
| 61020-CPT | Low | Ventricular Puncture Through Previous Burr Hole, Fontanelle, Suture, Or Implanted Ventricular Catheter/Reservoir; Without Injection |
| 61026-CPT | Low | Ventricular Puncture Through Previous Burr Hole, Fontanelle, Suture, Or Implanted Ventricular Catheter/Reservoir; With Injection Of Medication Or Other Substance For Diagnosis Or Treatment |
| 61105-CPT | Moderate | Puncture Ventric W Twist Drill |
| 61250-CPT | High | Trephine W Explor Supratentor Unil |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61250 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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