CPT 61315 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 • 23 - Emergency Room • 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 61315 by major payers:
$2,699.88
$2,824.15
$2,961.16
$3,401.57
| 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 61315 | ||||||
United | 61315 | $271.00 | 1700263415 - NORTH POINT SURGERY CENTER, LLC | 464488421 - (MO) NORTH POINT SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $983.00 | 1891253035 - ADVANCED CENTER FOR SURGERY, THE ADVANCED CENTER FOR SURGERY | 611917634 - (FL) ADVANCED CENTER FOR SURGERY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $1064.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $1536.00 | 1982942298 - STOCKTON OUTPATIENT SURGERY CENTER LLC, AMBULATORY SURGERY CENTER OF STOCKTON | 371709575 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $728.00 | 1700842358 - THE EYE SURGERY CENTER OF THE CAROLINAS LP | 205562797 - (NC) THE EYE SURGERY CENTER OF THE CAROLINAS LP | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $591.00 | 1033102140 - SSC HOLDINGS LLC, SEDONA SURGERY CENTER | 470887316 - (CA) SSC HOLDINGS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $1997.00 | 1053562959 - PROHEALTH ALIGNED LLC, PROHEALTH CARE MORELAND SURGERY CENTER | 263324572 - (WI) PROHEALTH ALIGNED LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $408.00 | 1902875438 - CENTRAL PARK ENDOSCOPY CENTER LLC, ENDOSCOPY CENTER AT CENTRAL PARK | 752894418 - (TX) CENTRAL PARK ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $983.00 | 1831525112 - LONGLEAF SURGERY CENTER, LLC | 462421622 - (FL) LONGLEAF SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $1064.00 | 1174802045 - LEONARDTOWN SURGERY CENTER LLC | 452019132 - (MD) LEONARDTOWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $390.00 | 1881962348 - CENTER FOR SPINE AND PAIN MEDICINE PC, CSPM CHATTANOOGA ASC | 341976829 - CENTER FOR SPINE AND PAIN MEDICI | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $400.00 | 1043411648 - COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC | 562402712 - (GA) COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $408.00 | 1497724942 - PARK VENTURA ENDOSCOPY CENTER, LLC, DIGESTIVE HEALTH CENTER OF PLANO | 412059014 - (TX) PARK VENTURA ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $514.00 | 1396738936 - WARREN GASTRO ENDOSCOPY CTR INC | 341850936 - (OH) WARREN GASTRO ENDOSCOPY CTR INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61315 | $259.00 | 1548582463 - CAREPLEX ORTHOPAEDIC AMBULATORY SURGERY CENTER, LLC, NONE | 271867311 - (VA) CAREPLEX ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC | VA | 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 61315 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61315 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 61315 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 |
|---|---|---|
| 61210-CPT | Moderate | Burr Hole(S); For Implanting Ventricular Catheter, Reservoir, Eeg Electrode(S), Pressure Recording Device, Or Other Cerebral Monitoring Device (Separate Procedure) |
| 61313-CPT | High | Evac Hematoma Supratent-Cerebral |
| 61314-CPT | High | Craniectomy/Otomy-Hematoma,Infra;Extra-/ |
| 61315-CPT | High | Evac Hematoma Infratent-Cerebellar |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61315. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61315 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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