CPT 61564 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 |
| Common Modifiers | • None • 51 - Multiple procedures • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 61564 |
National average reimbursement for CPT 61564 by major payers:
$3,167.33
$3,281.22
$3,269.15
$3,938.04
| 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 61564 | ||||||
United | 61564 | $2732.00 | 1427055425 - PHYSICIANS PAVILION LP, PHYSICIANS PAVILION SURGERY CENTER | 830619935 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $1167.00 | 1962405803 - MID RIVERS AMBULATORY SURGERY CENTER LP, MID RIVERS SURGERY CENTER | 203833902 - (MO) MID RIVERS AMBULATORY SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $820.00 | 1457329963 - SEQUOIA SURGERY CENTER, LLC, CYPRESS SURGERY CENTER, A LIMITED PARTNERSHIP | 770326275 - (CA) SEQUOIA SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $9124.00 | 1750415220 - TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | 751977850 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $1361.00 | 1558524298 - SAINT FRANCIS GI ENDOSCOPY L.L.C | 205540278 - (CT) SAINT FRANCIS GI ENDOSCOPY LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $700.00 | 1538782743 - HUEBNER CREEK SURGERY CENTER, PLLC | 813360799 - (TX) HUEBNER AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $3434.00 | 1356480099 - MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $1124.00 | 1174185649 - PISA ASC HOLDCO LLC, PAIN INSTITUTE OF SOUTHERN ARIZONA PROCEDURE CENTER | 831944129 - (AZ) PISA ASC HOLDCO LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $995.00 | 1366041469 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $700.00 | 1467559625 - WINCHESTER EYE SURGERY CENTER, LLC | 203055242 - (VA) WINCHESTER EYE SURGERY CENTER, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $724.00 | 1194790808 - DIGESTIVE ENDOSCOPY CENTER LLC | 311508446 - (OH) DIGESTIVE ENDOSCOPY CENTER, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $374.00 | 1679737043 - FRIENDSHIP SURGERY CENTER | 261779956 - (GA) FRIENDSHIP SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $298.00 | 1114906393 - PHYSICIANS SURGERY CENTER LLC | 200435814 - (AR) PHYSICIANS SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $936.00 | 1134126097 - PHYSICIAN'S SURGERY CENTER OF KNOXVILLE LLC | 621777892 - (TN) PHYSICIANS SURGERY CENTER OF KNOXVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61564 | $1274.00 | 1184635955 - SAN RAMON ENDOSCOPY CENTER INC | 680466508 - (CA) SAN RAMON ENDOSCOPY CENTER INC | CA | 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 61564 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61564 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 61564 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 61564. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61564 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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