CPT 61321 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 78 - Return to OR - related procedure • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
National average reimbursement for CPT 61321 by major payers:
$2,667.84
$2,894.22
$2,962.45
$3,477.55
| 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 61321 | ||||||
United | 61321 | $115.00 | 1447220082 - WESTERN PA SURGERY CENTER, WEXFORD BRANCH, LLC, WESTERN PA SURGERY CENTER | 251826912 - (PA) WESTERN PA SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $1064.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $519.00 | 1356773584 - SURGERY CENTER OF MUNSTER, LLC, THE CENTER FOR MINIMALLY INVASIVE SURGERY | 461961043 - (IN) SURGERY CENTER OF MUNSTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $2787.00 | 1184937468 - GRASS VALLEY OUTPATIENT SURGERY CENTER LP, GRASS VALLEY SURGERY CENTER | 272185264 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $508.00 | 1134777832 - PETERS ENDOSCOPY CENTER, LLC | 842583326 - (NC) PETERS ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $750.00 | 1396065082 - PAIN CENTERS OF MINNESOTA-MANKATO, LLC | 272452351 - (MN) PAIN CENTERS OF MINNESOTA-MANKATO, LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $249.00 | 1891175188 - PHOENIX SPINE GOODYEAR ASC, LLC, PHOENIX SPINE SURGERY CENTER | 853605981 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $500.00 | 1790265999 - MUVE | 822351627 - (PA) MUVE | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $690.00 | 1073663480 - DOCTORS CLINIC A PROFESSIONAL CORPORATION, THE DOCTORS CLINIC AMBULATORY SURGERY CENTER | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $702.00 | 1558480947 - ISSAQUAH FOOT & ANKLE SPECIALISTS PLLC | 454029230 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $2652.00 | 1184687626 - PARK CENTRAL SURGICAL CENTER, LTD, MEDICAL CITY SURGERY CENTER/PARK CENTRAL | 752290624 - (TX) PARK CENTRAL SURGICAL CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $2233.00 | 1700341468 - PORT WARWICK SURGERY CENTER, LLC | 832749039 - (VA) PORT WARWICK SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $109.00 | 1043239338 - NORTH VALLEY ENDOSCOPY CENTER LLC | 201729172 - (AZ) NORTH VALLEY ENDOSCOPY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $775.00 | 1336562156 - RYE SURGICAL CENTER, LLC | 463464240 - (NH) RYE SURGICAL CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61321 | $296.00 | 1356463913 - MODESTO SURGERY CENTER LLC | 770394007 | CA | 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 61321 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61321 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 61321 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 |
|---|---|---|
| 61070-CPT | Low | Punc Shunt Tube/Reservoir-Aspir/Inj |
| 61108-CPT | High | Twist Drill Hole(S) For Subdural, Intracerebral, Or Ventricular Puncture; For Evacuation And/Or Drainage Of Subdural Hematoma |
| 61321-CPT | High | Drainage Abscess Infratentorial |
| 61460-CPT | High | Craniectomy,Suboccipital;Sect,1/More Cra |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61321. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61321 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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