CPT 61536 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 |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • 82 - Assistant surgeon - no qualified resident |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 61536 |
National average reimbursement for CPT 61536 by major payers:
$3,303.98
$3,531.59
$3,724.25
$4,227.44
| 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 61536 | ||||||
United | 61536 | $1177.00 | 1467057372 - SOUTHWEST CONNECTICUT SURGERY CENTER, LLC | 852607391 - (CT) SOUTHWEST CONNECTICUT SURGERY CENTER, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $736.00 | 1437597812 - VIVERE HEALTH AUSTIN, LLC, VIVERE AUSTIN SURGERY CENTER | 611694454 - (TX) VIVERE HEALTH AUSTIN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $11727.00 | 1750415220 - TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | 751977850 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $750.00 | 1124571104 - UROLOGY SURGERY CENTER JOHNS CREEK LLC | 811521583 - (GA) UROLOGY SURGERY CENTER JOHNS CREEK LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $404.00 | 1487094058 - COMPREHENSIVE PAIN CENTER FOR SURGERY, FOUNTAINS SPECIALTY SURGICAL CENTER | 460896509 - (MS) COMPREHENSIVE PAIN CENTER FOR SURGERY | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $501.00 | 1164448486 - CHRISTUS SANTA ROSA PASC-SAN ANTONIO LLC, CHRISTUS SANTA ROSA PHYSICIANS AMBULATORY SURGERY CENTER-STONE OAK | 412092141 - (TX) CHRISTUS SRPASC - SAN ANTONIO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $729.00 | 1316924632 - CAROLINA BONE & JOINT SURGERY CENTER | 134241163 - (SC) CAROLINA BONE & JOINT SURGERY | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $1367.00 | 1316109309 - PROLIANCE SURGEONS INC PS, PLASTIC & RECONSTRUCTIVE SURGEONS ASC | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $307.00 | 1922016898 - JAMES TRICE MD PA, DIGESTIVE DISEASE CENTER | 710758882 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $1049.00 | 1871751859 - WESTMINSTER SURGERY CENTER | 262059600 - (MD) WESTMINSTER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $1049.00 | 1366416125 - TEXAS ORTHOPEDICS SURGERY CENTER, LLC, TEXAS ORTHOPEDICS SURGERY CENTER LIMITED PARTNERSHIP, LL | 743013713 - (TX) TEXAS ORTHOPEDICS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $1028.00 | 1821421256 - MONOCACY SURGERY CENTER LLC | 462861862 - (MD) MONOCACY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $2705.00 | 1639850415 - MEDICAL CITY SURGERY CENTER OF ALLEN, LLC | 932106228 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $475.00 | 1396030664 - CATARACT INSTITUTE OF OKLAHOMA LLC | 452035458 - (OK) CATARACT INSTITUTE OF OKLAHOMA LLC 401(K) PLAN AND TRUST | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61536 | $451.00 | 1649921065 - JOINT REPLACEMENT CENTER OF LOUISIANA | 874022126 - (LA) JOINT REPLACEMENT CENTER OF LOUS | LA | 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 61536 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61536 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 61536 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 |
|---|---|---|
| 61531-CPT | High | Subdural Implantation Of Strip Electrodes Through One Or More Burr Or Trephine Hole(S) For Long Term Seizure Monitori |
| 61533-CPT | High | Craniotomy With Elevation Of Bone Flap; For Subdural Implantation Of An Electrode Array, For Long-Term Seizure Monitoring- Rn Review=12/8/2007-9/13/2021 |
| 61534-CPT | High | Craniectomy, Trephination, Bone Flap Craniotomy; For Excision Of Epileptogenic Focus Without Electrocortico |
| 61536-CPT | High | Craniotomy With Elevation Of Bone Flap; For Excision Of Cerebral Epileptogenic Focus, With Electrocorticography During Surgery (Includes Removal Of Electrode Array) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61536. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61536 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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