CPT 61563 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 • LT - Left side of body • 22 - Increased Procedural Services |
| Complexity Level | High |
National average reimbursement for CPT 61563 by major payers:
$2,665.13
$2,684.68
$2,715.66
$3,240.63
| 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 61563 | ||||||
United | 61563 | $644.00 | 1356421853 - PINEHURST MEDICAL CLINIC INC, PINEHURST MEDICAL CLINIC ENDOSCOPY CENTER | 560942980 - (NC) PINEHURST MEDICAL CLINIC, INC. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $5554.00 | 1952331092 - MEMORIAL HERMANN SURGERY CENTER SUGAR LAND LLP | 203233617 - (TX) MEMORIAL HERMANN SURGERY CENTER SUGAR LAND LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $972.00 | 1629079058 - CARES SURGICENTER LLC | 223557777 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $406.00 | 1205454626 - EYE SURGERY CENTER OF WISCONSIN, LLC | 833779684 - (WI) EYE SURGERY CENTER OF WISCONSIN, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $2013.00 | 1811101439 - SENTARA OBICI AMBULATORY SURGERY, LLC | 260144898 - (VA) SENTARA OBICI AMBULATORY SURGERY, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $1954.00 | 1568963189 - BAPTIST SURGERY AND ENDOSCOPY CENTERS, LLC, BAPTIST HEALTH ENDOSCOPY CENTER AT MIAMI BEACH | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $16050.00 | 1902052350 - SURGERY CENTER, LLC | 263169180 - (WI) THE SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $1028.00 | 1104298009 - RED CEDAR SURGERY CENTER, LLC, RED CEDAR SURGERY CENTER, PLLC | 472947364 - (MI) RED CEDAR SURGERY CENTER, PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $1367.00 | 1457891426 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE CENTER FOR OUTPATIENT SPINE AND JOINT SURGERY | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $492.00 | 1700828423 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $7400.00 | 1679892913 - BELTWAY SURGERY CENTERS, L.L.C. | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $424.00 | 1346215316 - CHESAPEAKE EYE SURGERY CENTER, LLC | 522310068 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $1306.00 | 1144291261 - OCEAN SURGICAL PAVILION, PC, OCEAN SURGICAL PAVILION | 223182653 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $775.00 | 1568060655 - WESTERN PA SURGERY CENTER, BEAVER COUNTY BRANCH, LLC | 824214966 - (PA) WESTERN PA SURGERY CENTER BEAVER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $310.00 | 1013999580 - INTEG HEALTH SYSTEM, P.C., BLOOMINGTON SURGERY CENTER | 352045236 - (IN) INTEG HEALTH SYSTEM PC | IN | 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 61563 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61563 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 61563 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 |
|---|---|---|
| 61563-CPT | High | Excision, Intra And Extracranial, Benign Tumor Of Cranial Bone (Eg, Fibrous Dysplasia); Without Optic Nerve Decompression |
| 61564-CPT | High | Excision, Intra- And Extracranial, Benign Tumor Of Cranial Bone (Eg, Fibrous Dysplasia); With Optic Nerve Decompression |
| 61570-CPT | High | Craniectomy/Craniotomy;Exc.For. Bdy |
| 61571-CPT | High | Craniectomy For Penetrating Wound |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61563. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61563 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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