CPT 61304 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 78 - Return to OR - related procedure |
| Complexity Level | High |
National average reimbursement for CPT 61304 by major payers:
$2,048.53
$2,244.14
$2,369.84
$2,706.14
| 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 61304 | ||||||
United | 61304 | $236.00 | 1215967351 - FRIENDSHIP AMBULATORY SURGERY CENTER, FRIENDSHIP AMBULATORY SURGERY CENTER | 521873474 - (MD) FRIENDSHIP AMBULATORY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $6068.00 | 1023316197 - NORTH DALLAS SURGICAL CENTER,LLC, TEXAS HEALTH SURGERY CENTER ADDISON | 272248103 - (TX) NORTH DALLAS SURGICAL CENTERLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $550.00 | 1689188823 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | 593646134 - (FL) FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $384.00 | 1649735861 - KURESMART PAIN MANAGEMENT SURGERY CENTER-CATONSVILLE LLC, CLEARWAY SURGERY CENTER OF CATONSVILLE | 832414671 - (MD) KURESMART PAIN MANAGEMENT SURGERY CENTERCATONSVILLE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $2785.00 | 1518359181 - ARAPAHOE SURGICENTER, LLC | 472388780 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $1049.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $183.00 | 1386885556 - THE ASC AT WAUGH CHAPEL | 263869837 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $1348.00 | 1942230024 - LUTHERVILLE ENDOSCOPY CENTER LLC | 823193901 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $100.00 | 1679566582 - FOREST CANYON ENDOSCOPY & SURGERY CTR PC | 460504121 - (AZ) FOREST CANYON ENDOSCOPY & SURGERY CENTER, PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $354.00 | 1265437743 - REGIONAL UROLOGY ASC LLC | 721455456 - (LA) REGIONAL UROLOGY ASC LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $983.00 | 1548241623 - GASTROENTEROLOGY ASSOCIATES, LLC, GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER | 912104493 - (WA) GASTROENTEROLOGY ASSOCIATES PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $775.00 | 1316350275 - ORCHARD SURGICAL CENTER, LLC, ORCHARD SURGICAL CENTER | 465568612 - (NH) ORCHARD SURGICAL CENTER, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $457.00 | 1093907339 - TAYLOR SURGERY CENTER, LLC, SURGICAL ARTS SURGERY CENTER | 710860395 - (AR) TAYLOR SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $682.00 | 1649944521 - PRECISION BONE AND JOINT SURGERY CENTER | 861302912 - (FL) PRECISION BONE AND JOINT SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61304 | $1049.00 | 1720325160 - SURGCENTER OF DEER VALLEY, LLC | 461512703 - (AZ) SURGCENTER OF DEER VALLEY LLC | AZ | 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 61304 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61304 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 61304 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 |
|---|---|---|
| 61107-CPT | Moderate | Twist Drill Hole(S) For Subdural, Intracerebral, Or Ventricular Puncture; For Implanting Ventricular Catheter, Pressure Recording Device, Or Other Intracerebral Monitoring Device |
| 61210-CPT | Moderate | Burr Hole(S); For Implanting Ventricular Catheter, Reservoir, Eeg Electrode(S), Pressure Recording Device, Or Other Cerebral Monitoring Device (Separate Procedure) |
| 61304-CPT | High | Craniectomy/Craniotomy,Explor;Supratento |
| 61305-CPT | High | Exploration Infratentorial |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61304. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61304 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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