CPT 61559 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 • 62 - Co-Surgeons • 80 - Assistant surgeon |
| Complexity Level | High |
National average reimbursement for CPT 61559 by major payers:
$3,099.51
$3,170.46
$3,333.73
$3,839.99
| 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 61559 | ||||||
United | 61559 | $413.00 | 1609930676 - BAYWOOD MEDICAL ASSOCIATES, PLLC, DESERT PAIN INSTITUTE - ASC | 861006533 - (AZ) BAYWOOD MEDICAL ASSOCIATES, PLLC DBA DESERT PAIN INSTITUTE | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $646.00 | 1821167479 - EVERGREEN EYE CENTER, PLLC, EVERGREEN EYE SURGERY CENTER | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $650.00 | 1962953018 - THE SURGERY CENTER AT TGH BRANDON HEALTHPLEX LLC | 611795393 - (FL) THE SURGERY CENTER AT TGH BRANDON HEALTHPLEX LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $440.00 | 1487627642 - SURGERY CENTER OF CORAL GABLES LLC, SURGERY CENTER OF CORAL GABLES LLC | 621827649 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $1500.00 | 1205171295 - VANCE THOMPSON VISION SURGERY CENTER PROF LLC, VANCE THOMPSON VISION SURGERY CENTER | 455323939 | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $1049.00 | 1346237328 - VICTORIA AMBULATORY SURGERY CENTER, LP, THE SURGERY CENTER | 352240144 - (TX) VICTORIA AMBULATORY SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $1064.00 | 1942472931 - SURGCENTER OF GLEN BURNIE, SURGCENTER OF GLEN BURNIE, LLC | 261572774 - (MD) SURGCENTER OF GLEN BURNIE, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $1064.00 | 1649223124 - CAMP LOWELL SURGERY CENTER,LLC, CAMP LOWELL SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $434.00 | 1821250176 - NORTHSHORE AMBULATORY SURGERY CENTER LLC | 800352092 - (LA) NORTHSHORE AMBULATORY SURGERY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $1028.00 | 1548241623 - GASTROENTEROLOGY ASSOCIATES, LLC, GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER | 912104493 - (WA) GASTROENTEROLOGY ASSOCIATES PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $625.00 | 1558390781 - BAPTIST-PHYSICIANS SURGERY CENTER | 43665929 - (KY) BAPTIST-PHYSICIANS SURGERY CENT | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $2732.00 | 1538122569 - CENTENNIAL SURGERY CENTER LP | 621624530 - (TN) CENTENNIAL SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $900.00 | 1588119283 - DOCTORS OUTPATIENT SURGERY CENTER LLC, DOCTORS OUTPATIENT SURGERY CENTER | 364835603 - (NE) DOCTORS OUTPATIENT SURGERY CENTER, LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $413.00 | 1841347143 - RUXTON SURGICENTER LLC | 522095835 - (MD) RUXTON SURGICENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61559 | $715.00 | 1750528717 - ROUND ROCK SURGERY CENTER LLC, ADVANCED SURGICAL CENTER - ROUND ROCK | 260856139 - (TX) ROUND ROCK SURGERY CENTER LLC | TX | 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 61559 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61559 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 61559 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 |
|---|---|---|
| 61550-CPT | High | Craniect. For Craniosyn.;1 Sut |
| 61552-CPT | High | Craniectomy Strip Multiple 1 Stage |
| 61556-CPT | High | Craniotom. For Craniosyn;Bne Flp |
| 61559-CPT | High | Extensive Craniectomy For Multiple Cranial Suture Craniosynostosis (Eg, Cloverleaf Skull); Recontouring With Multiple Osteotomies And Bone Autografts (Eg, Barrel-Stave Procedure) (Includes Obtaining Grafts) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61559. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61559 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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