CPT 63056 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 • 59 - Distinct Procedural Service • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 63056 |
National average reimbursement for CPT 63056 by major payers:
$1,815.69
$2,043.91
$2,153.49
$2,481.19
| 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 63056 | ||||||
United | 63056 | $6259.00 | 1841858024 - VANGUARD ASC, LLC, VANGUARD SURGICAL CENTER | 352661529 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $8535.00 | 1386165504 - THE EMORY CLINIC INC, EMORY AMBULATORY SURGERY CENTER AT SPIVEY STATION | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $6492.00 | 1548241623 - GASTROENTEROLOGY ASSOCIATES, LLC, GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER | 912104493 - (WA) GASTROENTEROLOGY ASSOCIATES PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $4000.00 | 1063531911 - NJ VEIN & COSMETIC SURGERY CENTER, PA | 223328362 - (NJ) NJ VEIN COSMETIC SURGERY CENTER PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $3569.00 | 1477502979 - INLAND EAR NOSE AND THROAT A MEDICAL GROUP INC, FOOTHILL AMBULATORY SURGERY CENTER | 953300822 - (CA) M.M. KANOK, M.D., A MEDICAL CORPORA | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $3500.00 | 1518129576 - USC AMBULATORY SURGICAL CENTER PROF LLC | 208907202 - (SD) USC AMBULATORY SURGICAL CENTER PROF LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $2692.00 | 1295714301 - ENDOSCOPY CENTER OF SOUTHEAST TEXAS LP, ENDOSCOPY CENTER OF SOUTHEAST TEXAS | 621536529 - (TX) ENDOSCOPY CENTER OF SOUTHEAST TEXAS LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $14053.00 | 1659839686 - AURORA SURGERY CENTERS, LLC | 811401714 - (WI) AURORA SURGERY CENTERS LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $7900.00 | 1104301613 - LOGAN SURGICAL SUITES LLC, ADVANCED SURGERY CENTER OF NORTHERN UTAH | 822435405 - (UT) LOGAN SURGICAL SUITES LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $3300.00 | 1629256961 - BELMONT/HARLEM SURGERY CENTER, LLC | 412237612 - (IL) BELMONT/HARLEM SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $2126.00 | 1629404918 - CENTRAL ARKANSAS SURGERY CENTER, LLC | 462585307 - (AR) CENTRAL ARKANSAS SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $2673.00 | 1194214510 - SPECIALTY SURGERY & LASER CENTER | 822989454 - (MS) SPECIALTY SURGERY LASER CENTER | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $6492.00 | 1366449571 - SHORE OUTPATIENT SURGICENTER LLC | 582252127 - (NJ) SHORE OUTPATIENT SURGICENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $2219.00 | 1528151586 - ENDOSCOPIC SURGICAL CENTRE OF MARYLAND-NORTH LLC, ENDOSCOPIC SURGICAL CENTRE OF MARYLAND NORTH | 208004241 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63056 | $2650.00 | 1518323435 - SOUTHTOWNS SURGERY CENTER LLC | 464742028 - (NY) SOUTHTOWNS SURGERY CENTER LLC | NY | 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 63056 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 63056 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 63056 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 |
|---|---|---|
| 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) |
| 63057-CPT | Moderate | Transpedicular Approach With Decompression Of Spinal Cord, Equina And/Or Nerve Root(S) (Eg, Herniated Intervertebral Disc), Single Segment; Each Additional Segment, Thoracic Or Lumbar (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 63056. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 63056 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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