CPT 61343 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 • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 61343 |
National average reimbursement for CPT 61343 by major payers:
$2,866.71
$3,005.09
$3,262.16
$3,616.82
| 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 61343 | ||||||
United | 61343 | $2746.00 | 1538122684 - KISSIMMEE SURGICARE LTD | 752407306 - (FL) KISSIMMEE SURGICARE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $3557.00 | 1396342838 - LEXINGTON HEALTH INC, LMC IRMO ASC | 852276567 - LEXINGTON HEALTH INC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $350.00 | 1063437994 - TRI-CITIES ENDOSCOPY CENTER PC, THE CENTER FOR DIGESTIVE WELLNESS | 621867929 - (TN) TRICITIES ENDOSCOPY CENTER PC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $494.00 | 1194790592 - UPMC HAMOT SURGERY CENTER, LLC | 251863661 - (PA) UPMC HAMOT SURGERY CENTER, L.L.C. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $210.00 | 1790167740 - TIDALHEALTH SURGERY CENTER, LLC | 474184623 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $591.00 | 1730783523 - ORTHOARIZONA SCOTTSDALE ASC, LLC | 843527783 - (AZ) ORTHOARIZONA SCOTTSDALE ASC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $1064.00 | 1912434697 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $1028.00 | 1841395894 - FRANKLIN ENDOSCOPY CENTER, LLC, FRANKLIN ENDOSCOPY CENTER | 383730672 - (TN) FRANKLIN ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $2705.00 | 1205327277 - AUSTIN GI SURGICENTER, LLC, AUSTIN ENDOSCOPY CENTER | 301073754 - (TX) AUSTIN GI SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $194.00 | 1881875227 - SKIN & MOHS SURGERY CENTER, LLC | 431823843 - SKIN MOHS SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $340.00 | 1366710741 - THE EYE PHYSICIANS OF PINELLAS, PA, LARGO AMBULATORY SURGERY CENTER | 593400241 - (FL) THE EYE PHYSICIANS OF PINELLAS, P.A. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $290.00 | 1043271604 - NORTH FULLERTON SURGERY CENTER, LLC | 223849885 - (NJ) NORTH FULLERTON SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $771.00 | 1407807050 - EL PASO DAY SURGERY LLC, EL PASO DAY SURGERY, L.P. | 200285362 - (TX) EL PASO DAY SURGERY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $1630.00 | 1871895821 - GWINNETT SURGERY CENTER, LLC | 272819709 - (GA) GWINNETT SURGERY CENTER,LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61343 | $440.00 | 1831636752 - RIVER VIEW SURGERY CENTER, LLC | 814790945 - (ID) RIVER VIEW SURGERY CENTER, LLC | ID | 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 61343 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61343 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 61343 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 |
|---|---|---|
| 61050-CPT | Low | Puncture Cisternal |
| 61250-CPT | High | Trephine W Explor Supratentor Unil |
| 61321-CPT | High | Drainage Abscess Infratentorial |
| 61343-CPT | High | Craniectomy, Suboccipital With Cervical Laminectomy For Decompression Of Medulla And Spinal Cord, With Or Without Dural Graft (Eg, Arnold-Chiari Malformation) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61343. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61343 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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