CPT 63005 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 • 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 63005 |
National average reimbursement for CPT 63005 by major payers:
$1,516.63
$1,617.39
$1,751.14
$1,979.22
| 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 63005 | ||||||
United | 63005 | $2724.00 | 1154301240 - ENDOSCOPY CENTER OF WASHINGTON DC LP, THE ENDOSCOPY CENTER OF WASHINGTON, D.C. | 621543524 - (DC) ENDOSCOPY CENTER OF WASHINGTON DC LP | DC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $2732.00 | 1427003904 - PHILADELPHIA WOMEN'S CENTER, INC. | 232476628 - (PA) PHILADELPHIA WOMENS CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $3275.00 | 1316991938 - SURGICAL AND DIAGNOSTIC CENTER, L.P. | 752874229 - (TX) SURGICAL AND DIAGNOSTIC CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $3669.00 | 1598349839 - NAADI MANTECA ASC | 863449917 - (CA) NAADI MANTECA ASC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $8394.00 | 1295344026 - WEST CHESTER SURGICAL SUITES, LLC | 845072006 - (OH) WEST CHESTER SURGICAL SUITES LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $3657.00 | 1184106049 - SURGCENTER OF NORTHERN BALTIMORE, LLC | 823078615 - (MD) SURGCENTER OF NORTHERN BALTIMORE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $6492.00 | 1144954165 - ADVANCED SURGICAL CARE OF LUTZ, LLC, ADVANCED SURGICAL CARE OF NEW TAMPA | 871390521 - (FL) ADVANCED SURGICAL CARE OF LUTZ LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $5330.00 | 1205875283 - RWJ ENDOSURGICAL CENTER LLC | 900872940 - (NJ) RWJ ENDOSURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $1162.00 | 1972541415 - OCEAN ENDOSURGERY CENTER LLC, OCEAN ENDOSURGERY CENTER | 223564617 - (NJ) OCEAN ENDOSURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $2154.00 | 1558456459 - PORTLAND ENDOSCOPY CENTER | 10432678 - (ME) PORTLAND ENDOSCOPY CENTER | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $6492.00 | 1740794973 - EPIC ASC, LLC, EPIC SURGERY CENTER | 611859657 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $2800.00 | 1669405684 - PACIFICOAST AMBULATORY SURGICENTER, LLC., PACIFIC COAST AMBULATORY SURGICENTER | 474003673 - (CA) PACIFICOAST AMBULATORY SURGICENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $4635.00 | 1568906212 - HOUSTON UROLOGIC SURGICENTER, LLC | 814537533 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $900.00 | 1003273129 - GREAT LAKES SURGERY CENTER LLC | 465665524 - (MI) GREAT LAKES SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63005 | $12945.00 | 1891935201 - EAST CAMPUS SURGERY CENTER LLC | 352028517 - (IN) EAST CAMPUS SURGERY CENTER LLC | 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 63005 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 63005 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 63005 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 |
|---|---|---|
| 63003-CPT | High | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina, Without Facetectomy, Foraminotomy Or Discectomy (Eg, Spinal Stenosis), 1 Or 2 Vertebral Segments; Thoracic |
| 63005-CPT | High | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina, Without Facetectomy, Foraminotomy Or Discectomy (Eg, Spinal Stenosis), 1 Or 2 Vertebral Segments; Lumbar, Except For Spondylolisthesis |
| 63011-CPT | High | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina, Without Facetectomy, Foraminotomy Or Discectomy (Eg, Spinal Stenosis), 1 Or 2 Vertebral Segments; Sacral |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 63005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 63005 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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