CPT 61320 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 • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • 78 - Return to OR - related procedure • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 61320 |
National average reimbursement for CPT 61320 by major payers:
$2,373.75
$2,595.63
$2,716.40
$3,115.32
| 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 61320 | ||||||
United | 61320 | $2732.00 | 1083656318 - SURGERY CENTER OF OVERLAND PARK LP | 201011611 - (KS) SURGERY CENTER OF OVERLAND PARK LP | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $495.00 | 1255309951 - BAYFRONT SAME DAY SURGERY CENTER, LLC. | 845074208 - (FL) OHI WEST INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $457.00 | 1437512993 - UNITED SKIN SPECIALISTS MISSOURI LTD, PC, CHESTERFIELD ASC | 811166184 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $630.00 | 1871538694 - SOUTHWEST ENDOSCOPY LTD | 850452091 - (NM) SOUTHWEST ENDOSCOPY LTD | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $1231.00 | 1659793040 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $650.00 | 1053933952 - GASTROENTEROLOGY ASSOCIATES OF THE PIEDMONT, P.A., KERNERSVILLE ENDOSCOPY CENTER | 561251665 - (NC) GASTROENTEROLOGY ASSOCIATES OF THE PIEDMONT, PA | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $251.00 | 1033222989 - EMPIRE SURGERY CENTER | 770581233 - (CA) EMPIRE SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $412.00 | 1114025608 - ELLICOTT CITY AMBULATORY SURGERY CENTER, LLLP, ELLICOTT CITY AMBULATORY SURGERY CENTER | 631213860 - (MD) ELLICOTT CITY AMBULATORY SURGERY CENTER LLLP | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $968.00 | 1811262363 - PRECISION SURGERY CENTER, LLC | 453655088 - (KS) PRECISION SURGERY CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $1028.00 | 1538126362 - WINTER HAVEN AMBULATORY SURGICAL CENTER LLC | 593659906 - (FL) WINTER HAVEN AMBULATORY SURGICAL CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $620.00 | 1003816307 - SAGAMORE SURGICAL SERVICES, INC. | 351850819 - (IN) SAGAMORE SURGICAL SERVICES, INC. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $900.00 | 1346210259 - SURGICARE LLC | 351975122 - (IN) SURGICARE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $614.00 | 1497090740 - OLOL PONTCHARTRAIN SURGERY CENTER, LLC, OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER | 461379031 - (LA) OLOL PONTCHARTRAIN SURGERY CENTE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $299.00 | 1578077103 - SNNAC LLC, AZURA SURGERY CENTER NORTHERN NEVADA | 821669704 - (NV) SNNAC LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61320 | $475.00 | 1881193183 - SOUTHSIDE SPECIALTY SURGICAL CENTER LLC | 823920550 - (TX) SOUTHSIDE SPECIALTY SURGICAL CENTER LLC | TX | 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 61320 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61320 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 61320 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 |
|---|---|---|
| 61150-CPT | High | Burr Hole/Trep;Drain Brain Absc/Cys |
| 61253-CPT | High | Trephine Infratentorial |
| 61320-CPT | High | Craniectomy/Craniotomy,Drain Intracran.A |
| 61322-CPT | High | Craniectomy Or Craniotomy, Decompressive, With Or Without Duraplasty, For Treatment Of Intracranial Hypertension, Without Evacuation Of Associated Intraparenchymal Hematoma; Without Lobectomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61320. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61320 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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