CPT 63016 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 • 51 - Multiple procedures |
| Complexity Level | High |
National average reimbursement for CPT 63016 by major payers:
$1,915.88
$2,070.90
$2,226.47
$2,517.52
| 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 63016 | ||||||
United | 63016 | $9978.00 | 1811101439 - SENTARA OBICI AMBULATORY SURGERY, LLC | 260144898 - (VA) SENTARA OBICI AMBULATORY SURGERY, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $5330.00 | 1992713010 - NORTHFIELD SURGICAL CENTER LLC, NORTHFIELD SURGICAL CENTER | 223509801 - (NJ) NORTHFIELD SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $530.00 | 1023551413 - MID-BRONX ENDOSCOPY CENTER LLC | 471156630 - (NY) MIDBRONX ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $4651.00 | 1871119107 - REGIONAL PLASTIC SURGERY CENTER PA, REGIONAL PLASTIC SURGERY CENTER - SHERMAN | 752365055 - (TX) REGIONAL PLASTIC SURGERY ASSOCIATES, P.A. | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $21685.69 | 1649392242 - ST. CLAIR MEMORIAL HOSPITAL | 251010303 - (PA) ST CLAIR HEALTH CORPORATION | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $6000.00 | 1083715148 - ASC SURGICAL VENTURES, LLC, OSMC OUTPATIENT SURGERY CENTER | 351995261 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $840.00 | 1508054818 - CUMMINS WOMENS HEALTHCARE LLC, ELIZABETH CUMMINS MD | 522110421 - (OH) CUMMINS WOMENS HEALTHCARE, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $4500.00 | 1588203723 - SOUTHWEST CARDIOVASCULAR INTERVENTIONAL CENTER, LLC | 832560085 - (AZ) SOUTHWEST CARDIOVASCULAR INTERVENTIONAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $8110.00 | 1255361259 - CENTRAL JERSEY SURGERY CENTER LLC, CENTRAL JERSEY SURGERY CENTER | 582352848 - (NJ) CENTRAL JERSEY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $3843.00 | 1992759930 - IDAHO SURGICENTER INC, IDAHO SURGICENTER SOUTH | 200049792 - (ID) IDAHO SURGICENTER INC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $2000.00 | 1205978780 - MOUNTAIN HOME SURGERY CENTER | 454157268 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $8394.00 | 1396174454 - SURGERY CENTER OF SCOTTSDALE LLC | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $2650.00 | 1356890172 - DIALYSIS ACCESS SERVICES, LLC | 472322456 - (MD) DIALYSIS ACCESS SERVICES LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $8087.00 | 1083644124 - MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP, MEMORIAL HERMANN SURGERY CENTER SOUTHWEST | 202866884 - (TX) MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63016 | $5513.00 | 1841342789 - SURGERY CENTER JV, THE SURGERY CENTER OF HUNTSVILLE | 621230866 - (AL) THE SURGERY CENTER OF HUNTSVILLE | AL | 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 63016 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 63016 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 63016 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 |
|---|---|---|
| 63015-CPT | High | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina, Without Facetectomy, Foraminotomy Or Discectomy (Eg, Spinal Stenosis), More Than 2 Vertebral Segments; Cervical |
| 63016-CPT | High | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina, Without Facetectomy, Foraminotomy Or Discectomy (Eg, Spinal Stenosis), More Than 2 Vertebral Segments; Thoracic |
| 63017-CPT | High | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina, Without Facetectomy, Foraminotomy Or Discectomy (Eg, Spinal Stenosis), More Than 2 Vertebral Segments; Lumbar |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 63016. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 63016 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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