CPT 63055 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 63055 |
National average reimbursement for CPT 63055 by major payers:
$1,958.12
$2,228.24
$2,390.02
$2,697.89
| 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 63055 | ||||||
United | 63055 | $6492.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $4268.00 | 1841884731 - EYE MD OF NICEVILLE SURGERY LLC | 862163581 - (FL) EYE MD OF NICEVILLE SURGERY LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $6492.00 | 1558794081 - SURGERY CENTER OF SCOTTSDALE, LLC | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $6365.00 | 1194724690 - ENDOSCOPY CENTER OF DAYTON NORTH LLC | 311703317 - (OH) ENDOSCOPY CENTER OF DAYTON NORTH LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $3045.00 | 1588756621 - HIGHLINE SOUTH AMBULATORY SURGERY CENTER, LLC, HIGHLINE SOUTH AMBULATORY SURGERY CENTER | 205001199 - (CO) HIGHLINE SOUTH AMBULATORY SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $3350.00 | 1265859573 - MODESTO SPECIALTY SURGERY CENTER, PC | 454954897 - (CA) MODESTO SPECIALTY SURGERY CENTER PC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $6365.00 | 1881013142 - ADVANCED SURGERY CENTER OF TAMPA, LLC | 463891843 - (FL) ADVANCED SURGERY CENTER OF TAMPA, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $1934.00 | 1780699546 - CASCADES ENDOSCOPY CENTER, LLC, WHITEMARSH ENDOSCOPY CENTER | 203496335 - (MD) CASCADES ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $3275.00 | 1932856945 - UPPER VALLEY DIALYSIS ACCESS CENTER, LLC | 863328769 - (TX) UPPER VALLEY DIALYSIS ACCESS CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $1931.00 | 1013914985 - ROANOKE AMBULATORY SURGERY CENTER, LLC, ROANOKE AMBULATORY SURGERY CENTER | 10691564 - (VA) ROANOKE AMBULATORY SURGERY | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $6492.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $6087.00 | 1427152073 - PATIENT PARTNERS LLC | 201400198 - (TN) PATIENT PARTNERS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $5414.08 | 1609343052 - ADVANCED MEDICAL IMAGING SURGERY CENTER, LLC | 831444320 - (NE) ADVANCED MEDICAL IMAGING SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $3058.00 | 1790936847 - RSC SURGERY CENTER, LLC | 352345966 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63055 | $1185.00 | 1518967082 - NOVAMED SURGERY CENTER OF OAK LAWN, LLC, CENTER FOR RECONSTRUCTIVE SURGERY OF OAK LAWN | 770618674 - (IL) NOVAMED SURGERY CENTER OF OAK LAWN LLC | IL | 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 63055 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 63055 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 63055 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 |
|---|---|---|
| 63053-CPT | Moderate | Laminectomy, Facetectomy, Or Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord, Cauda Equina And/Or Nerve Root[S] [Eg, Spinal Or Lateral Recess Stenosis]), During Posterior Interbody Arthrodesis, Lumbar; Each Additional Segment (List Separately In Addition To Code For Primary Procedure) |
| 63055-CPT | High | Transpedicular Approach With Decompression Of Spinal Cord, Equina And/Or Nerve Root(S) (Eg, Herniated Intervertebral Disc), Single Segment; Thoracic |
| 63056-CPT | High | Transpedicular Approach With Decompression Of Spinal Cord, Equina And/Or Nerve Root(S) (Eg, Herniated Intervertebral Disc), Single Segment; Lumbar (Including Transfacet, Or Lateral Extraforaminal Approach) (Eg, Far Lateral Herniated Intervertebral Disc) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 63055. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 63055 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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