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 |
| Medicare Fee Schedule | View Medicare rates for 61563 |
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 | $1064.00 | 1265972087 - GOLDEN RIDGE ASC, LLC, GOLDEN RIDGE SURGERY CENTER | 820602141 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $617.00 | 1770837866 - SPINE AND PAIN PHYSICIANS SURGERY CENTER, LLC | 454831116 - (TN) SPINE AND PAIN PHYSICIANS SURGERY CENTER LLC | TN | 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 | $200.00 | 1679757959 - THOMAS JOHNSON SURGERY CENTER, LLC | 261579919 - (MD) THOMAS JOHNSON SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $443.00 | 1124492996 - MOHS AND SKIN SURGERY CENTER, LLC | 474284353 - (MD) MOHS AND SKIN SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $633.00 | 1235106782 - VALLEY SURGERY CENTER AT MODESTO, LLC, VALLEY SURGERY CENTER, LP | 200160879 - (CA) VALLEY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $225.00 | 1215245238 - AMERICAN ACCESS CARE OF NEW JERSEY, LLC, AZURA SURGERY CENTER CHERRY HILL | 223783657 - (NJ) AMERICAN ACCESS CARE OF NEW JERSEY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $1049.00 | 1245263292 - CHATTANOOGA PAIN MANAGEMENT CENTER LLC, CHATTANOOGA PAIN SURGERY CENTER | 320121593 - (TN) CHATTANOOGA PAIN MANAGEMENT | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $3500.00 | 1619972791 - AMBULATORY SURGERY CENTER OF SPARTANBURG, LLC | 571128350 - (SC) AMBULATORY SURGERY CENTER OF SPARTANBURG | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $550.00 | 1225023021 - ARC OF GEORGIA, LLC, PREMIER SURGERY CENTER | 621746313 - (GA) ARC OF GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $5729.00 | 1528069218 - NORTHSHORE REGIONAL MEDICAL CENTER DBA THE SURGERY SUITE, THE SURGERY SUITE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $951.00 | 1629461934 - NORTHERN EC LLC | 464211412 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $529.00 | 1215522727 - PREMIER 2020, LLC, PREMIER SURGICAL CENTER | 863194124 - (PA) PREMIER 2020 LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $1049.00 | 1780128553 - CAROLINAS ENDOSCOPY CENTER LLC | 814599818 - CAROLINAS ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61563 | $248.00 | 1063040731 - POWDER RIVER SURGERY CENTER | 845166436 | WY | 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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