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 |
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 | $1064.00 | 1326435926 - SELECT PHYSICIANS SURGERY CENTERS | 383935220 - (FL) SELECT PHYSICIANS SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $578.00 | 1336103001 - PERKINS PLAZA AMBULATORY SURGERY CENTER LLC, LAKE SURGERY CENTER | 481264699 - (LA) LAKE ASC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $316.00 | 1578600979 - HOTCHKISS AND KATZEN AMBULATORY SURGICAL CENTER, METRO AMBULATORY SURGICAL CENTER | 522048920 - (MD) HOTCHKISS AND KATZEN AMBULATORY SURGICAL CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $867.00 | 1912600826 - SURGICAL CENTER OF TVH | 882585662 - (ID) SURGICAL CENTER OF TVH | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $300.00 | 1669075495 - SAINT JOSEPH HEALTH ASC LLC | 611235517 - (KY) THE PAIN TREATMENT CENTER, INC. DBA STONE ROAD S | KY | 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 | $410.00 | 1346288032 - ENDOSCOPY CENTER AT RIDGE PLAZA LP, ENDOSCOPY CENTER AT MEDPOINT | 383656538 - (TX) ENDOSCOPY CENTER AT MED POINT | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $6068.00 | 1770145351 - TEXAS HEALTH SPINE SURGERY CENTER ALLIANCE LLC | 320571301 - (TX) TEXAS HEALTH SPINE SURGERY CENTER ALLIANCE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $715.00 | 1629713730 - PG COUNTY ENDOSCOPY CENTER LLC | 881766792 - (MD) PG COUNTY ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $1020.00 | 1063493443 - SEDALIA SURGERY CENTER, LLC | 431944012 - (MO) SEDALIA SURGERY CENTER L L C | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $248.00 | 1063040731 - POWDER RIVER SURGERY CENTER | 845166436 | WY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $400.00 | 1104998558 - AMERICAN EYE SURGERY CENTER, INC. | 203774302 - (GA) AMERICAN EYE SURGERY CENTER INC | GA | 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 | $855.00 | 1225781891 - SURGERY NEVADA LLC | 874665425 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61864 | $1016.00 | 1528261195 - ORCHARD CREEK SURGERY CENTER | 770498874 - (CA) ORCHARD CREEK SURGERY CENTER | 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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