CPT 61516 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 • 23 - Emergency Room |
| 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 61516 |
National average reimbursement for CPT 61516 by major payers:
$2,405.07
$2,546.75
$2,672.18
$3,076.31
| 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 61516 | ||||||
United | 61516 | $1028.00 | 1750363461 - BARKLEY SURGICENTER, LLC | 650428622 - (FL) BARKLEY SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $150.00 | 1336649714 - HEALTHQARE SERVICES ASC LLC, HEALTHQARE SERVICES ASC LLC | 815460194 - (VA) HEALTHQARE SERVICES ASC LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $1997.00 | 1053562959 - PROHEALTH ALIGNED LLC, PROHEALTH CARE MORELAND SURGERY CENTER | 263324572 - (WI) PROHEALTH ALIGNED LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $2882.41 | 1124022595 - THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS, LLC, SURGERY CENTER CEDAR RAPIDS | 721550812 - (IA) THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $1049.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $4300.00 | 1982680492 - ROCKLAND SURGICAL PROJECT, LLC, RAMAPO VALLEY SURGICAL CENTER | 200580403 - (NJ) ROCKLAND SURGICAL PROJECT LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $600.00 | 1447472659 - BROCKTON ENDOSCOPY SURGERY CENTER LP | 61706315 - (CA) BROCKTON ENDOSCOPY SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $400.00 | 1407016561 - THOMASVILLE SURGERY CENTER, INC. | 582233903 - (GA) THOMASVILLE SURGERY CENTER INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $1595.00 | 1215211552 - PUTNAM GI, LLC, PUTNAM ENDOSCOPY ASC, LLC | 274431591 - (NY) PUTNAM GI LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $150.00 | 1366498347 - MINIMALLY INVASIVE SURGERY CENTER, P.A. | 223577926 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $335.00 | 1588667208 - BRADFORD PARKWAY SURGERY AND LASER CENTER | 20562180 - (MO) BRADFORD PARKWAY SURGERY AND LASER CENTER | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $318.00 | 1588802987 - NATIONAL PARK ENDOSCOPY CENTER, LLC, SOUTH CENTRAL ENDOSCOPY | 900881332 - (AR) NATIONAL PARK ENDOSCOPY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $582.00 | 1841589116 - RENAISSANCE SURGERY CENTER OF CHATTANOOGA, LLC | 273013392 - (TN) RENAISSANCE SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $608.00 | 1336375930 - JACKSON SURGERY CENTER, LLC | 204173305 - (AL) JACKSON SURGERY CENTER LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61516 | $468.00 | 1629576848 - CAROLINA INTERVENTIONAL PAIN INSTITUTE, LLC, CAROLINA INTERVENTIONAL PAIN INSTITUTE, LLC | 822281290 - (SC) CAROLINA INTERVENTIONAL PAIN INSTITUTE LLC | SC | 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 61516 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61516 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 61516 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 |
| 61156-CPT | High | Burr Holes;Aspir.Hematma/Cyst,Intra |
| 61322-CPT | High | Craniectomy Or Craniotomy, Decompressive, With Or Without Duraplasty, For Treatment Of Intracranial Hypertension, Without Evacuation Of Associated Intraparenchymal Hematoma; Without Lobectomy |
| 61516-CPT | High | Excision Cyst Supratentorial |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61516 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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