CPT 61458 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 |
National average reimbursement for CPT 61458 by major payers:
$2,556.65
$2,749.51
$2,876.50
$3,311.37
| 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 61458 | ||||||
United | 61458 | $515.00 | 1902981558 - LANE SURGERY CENTER, LLC | 931305103 - (OR) LANE SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $310.00 | 1295824100 - BETTER LIVING ENDOSCOPY CENTER | 640877920 - (MS) BETTER LIVING ENDOSCOPY CENTER | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $2732.00 | 1912993833 - SURGICENTER OF KANSAS CITY, LLC | 431828920 - (MO) SURGICENTER OF KANSAS CITY, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $1674.00 | 1396009346 - PARAMUS ENDOSCOPY LLC, ENDOSCOPY CENTER OF BERGEN COUNTY | 453979491 - (NJ) PARAMUS ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $624.00 | 1912174996 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $1000.00 | 1124612924 - MILWAUKEE SURGICENTER LLC | 854072458 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $670.00 | 1619998648 - PAIN CARE CENTER BOISE, LLC, PAIN CARE BOISE | 200197438 - (ID) PAIN CARE CENTER BOISE, L.L.C. | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $1167.00 | 1275545279 - SURGERY CENTER OF COLUMBIA LP | 205227138 - (MO) SURGERY CENTER OF COLUMBIA LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $936.00 | 1134126097 - PHYSICIAN'S SURGERY CENTER OF KNOXVILLE LLC | 621777892 - (TN) PHYSICIANS SURGERY CENTER OF KNOXVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $658.00 | 1346244845 - LAKELAND SURGICAL & DIAGNOSTIC CENTER LLP | 593346125 - (FL) LAKELAND SURGICAL AND DIAGNOSTIC CENTER LLP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $785.00 | 1609871847 - THE SURGERY CENTER, LLC | 582520623 - (GA) THE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $534.00 | 1487609335 - THE CENTER FOR AESTHETIC SURGERY LLC | 200431536 - (MD) THE CENTER FOR AESTHETIC SURGERY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $628.00 | 1235105248 - GURLEY SURGERY CENTER, THE GYN CENTER | 621159796 - (TN) GURLEY SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $1049.00 | 1386277069 - SOUTHWEST ENDOSCOPY LLC | 843623972 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61458 | $1049.00 | 1730318353 - GARDENDALE SURGICAL ASSOCIATES, LLC | 205936644 - (AL) GARDENDALE SURGICAL ASSOCIATES | AL | 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 61458 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61458 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 61458 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) |
| 61333-CPT | High | Exploration Orbit W Removal Lesion |
| 61345-CPT | High | Other Cranial Decompression, Posterior F |
| 61458-CPT | High | Explorat Cranial Nerves Suboccipit |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61458. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61458 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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