CPT 61312 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 • 23 - Emergency Room |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 78 - Return to OR - related procedure |
| Complexity Level | High |
National average reimbursement for CPT 61312 by major payers:
$2,545.19
$2,812.76
$3,010.44
$3,384.71
| 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 61312 | ||||||
United | 61312 | $2795.00 | 1255787867 - THE METROHEALTH SYSTEM, METROHEALTH SYSTEM PARMA AMBULATORY SURGERY CENTER | 346004382 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $2302.00 | 1245749258 - FOCUS HAND SURGICENTER LLC, FOCUS HAND AND ARM SURGERY CENTER | 822523843 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $649.00 | 1881845907 - NORTH PACIFIC DERMATOLOGY PS | 204269950 - (WA) NORTH PACIFIC DERMATOLOGY PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $523.00 | 1215275227 - ISPM ASC AT PIEDMONT, LLC | 455109249 - (GA) ISPM ASC AT PIEDMONT LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $765.00 | 1184164816 - DELRAY BEACH SURGICAL SUITES, LLC | 813054776 - (FL) DELRAY BEACH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $1800.00 | 1164458634 - SAINT FRANCIS SURGERY CENTER, LLC, SAINT FRANCIS SURGERY CENTER | 61641562 - (TN) SAINT FRANCIS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $519.00 | 1063584415 - CAROLINA DIGESTIVE HEALTH ASSOCIATES, PA, CAROLINA DIGESTIVE ENDOSCOPY CENTER | 561335864 - (NC) CAROLINA DIGESTIVE HEALTH ASSOCIATES, PA | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $63.00 | 1588962831 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $604.00 | 1437801388 - FRESENIUS ACCESS CARE PHYSICIANS OF MADISON ASC LLC | 863588248 - (WI) FRESENIUS ACCESS CARE PHYSICIANS OF MADISON ASC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $892.00 | 1184375545 - MEDPARK SPECIALIZED SURGERY, LLC | 863466448 - (ND) MEDPARK SPECIALIZED SURGERY LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $17689.00 | 1902052350 - SURGERY CENTER, LLC | 263169180 - (WI) THE SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $117.00 | 1336143734 - TORRANCE ENDOSCOPY AND SURGICAL AFFILIATES, INC, ENDOSCOPY CENTER AT SKYPARK | 954871082 - (CA) TORRANCE ENDOSCOPY AND SURGICAL AFFILIATES INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $1500.00 | 1437794625 - VANCE THOMPSON VISION SURGERY CENTER BILLINGS, LLC | 843362063 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $400.00 | 1013341734 - CENTER FOR PAIN AND SPINE, LLC | 463285029 - (GA) CENTER FOR PAIN AND SPINE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61312 | $978.00 | 1689059222 - GOLDSTEP AMBULATORY SURGERY CENTER, LLC | 465647464 - (NY) GOLDSTEP AMBULATORY SURGERY CENTER LLC | NY | 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 61312 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61312 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 61312 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 |
|---|---|---|
| 61108-CPT | High | Twist Drill Hole(S) For Subdural, Intracerebral, Or Ventricular Puncture; For Evacuation And/Or Drainage Of Subdural Hematoma |
| 61140-CPT | High | Trephine W Biopsy Brain/Lesion |
| 61312-CPT | High | Craniectomy/Otomy-Hematoma,Supra;Extra-/ |
| 61313-CPT | High | Evac Hematoma Supratent-Cerebral |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61312. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61312 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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