CPT 61864 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • GC - Service performed by resident under supervision • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 61864 |
National average reimbursement for CPT 61864 by major payers:
$390.53
$434.35
$429.92
$487.90
| 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 61864 | ||||||
United | 61864 | $1028.00 | 1215548524 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $1146.00 | 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 | 61864 | $2897.00 | 1477590545 - SOUTHERN HILLS MEDICAL CENTER, LLC, SOUTHERN HILLS HOSPITAL & MEDICAL CENTER | 743048428 - (NV) SOUTHERN HILLS MEDICAL CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $1200.00 | 1649223629 - ST. LUKE'S HOSPITAL OF DULUTH, ASPIRUS ST LUKES DULUTH SURGERY CENTER | 410714079 - ST LUKES HOSPITAL OF DULUTH | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $1954.00 | 1568963189 - BAPTIST SURGERY AND ENDOSCOPY CENTERS, LLC, BAPTIST HEALTH ENDOSCOPY CENTER AT MIAMI BEACH | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $836.00 | 1952868622 - YORK ENDOSCOPY CENTER LLC | 833765021 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $973.00 | 1083659866 - ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP, FOUNDATION SURGERY AFFILIATE OF SAN ANTONIO LP | 742976746 - (TX) ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $1049.00 | 1356396857 - HOLSTON VALLEY AMBULATORY SURGERY CENTER, LLC | 621816864 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $1100.00 | 1407812498 - LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP | 364119522 - (IL) LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $453.00 | 1710038534 - OUTPATIENT SURGICAL SPECIALTIES CENTER, LLC | 205596163 - (NE) OUTPATIENT SURGICAL SPECIALTIES CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $535.00 | 1992018790 - REVISION ADVANCED SURGERY CENTER INC | 200734091 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $300.00 | 1932207669 - EYE SURGICAL CENTER OF MISSISSIPPI | 200669972 - (MS) EYE SURGICAL CENTER OF MISSISSIPPI | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $807.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $545.00 | 1811933179 - KALAMAZOO ENDO CENTER LLC | 201582174 - (MI) KALAMAZOO ENDO CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $658.00 | 1629135843 - NAEEM M AKHTAR, MADERA AMBULATORY ENDOSCOPY CENTER | 770194609 - (CA) NAEEM M. AKHTAR, M.D. | 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 61864 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61864 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 61864 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 |
|---|---|---|
| 61850-CPT | High | Twst Drl/Brr Hole-Impl Elec;Corticl |
| 61863-CPT | High | Twist Drill Burr Hole Craniotomy Or Craniectomy With Stereotactic Implantation Of Neurostimulator Electrode Array In Subcortical Site (Eg Thalamus Globus Pallidus Subthalamic Nucleus Periventricular Periaqueductal Gray) Without Use Of Intraoperative Microelectrode Recording; First Array |
| 61864-CPT | Moderate | Twist Drill Burr Hole Craniotomy Or Craniectomy With Stereotactic Implantation Of Neurostimulator Electrode Array In Subcortical Site (Eg Thalamus Globus Pallidus Subthalamic Nucleus Periventricular Periaqueductal Gray) Without Use Of Intraoperative Microelectrode Recording; Each Additional Array (List Separately In Addition To Primary Procedure) |
| 61867-CPT | High | Twist Drill Burr Hole Craniotomy Or Craniectomy With Stereotactic Implantation Of Neurostimulator Electrode Array In Subcortical Site (Eg Thalamus Globus Pallidus Subthalamic Nucleus Periventricular Periaqueductal Gray) With Use Of Intraoperative Microelectrode Recording; First Array |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61864. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61864 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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