CPT 63086 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 • AS - PA/NP/CNS assistant at surgery • 62 - Co-Surgeons |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 63086 |
National average reimbursement for CPT 63086 by major payers:
$253.75
$267.35
$312.42
$318.86
| 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 63086 | ||||||
United | 63086 | $2652.00 | 1639804248 - WILLIS SURGICENTER, LLC | 842342776 - (TX) WILLIS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $4128.00 | 1447799580 - GENEVA SURGICAL SUITES, LLC | 811514537 - (WI) GENEVA SURGICAL SUITES, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $951.00 | 1629461934 - NORTHERN EC LLC | 464211412 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1313.00 | 1063019586 - GREENWAY SURGICAL SUITES, LLC | 853346468 - (MN) GREENWAY SURGICAL SUITES LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $424.00 | 1649322496 - SURGICARE SURGICAL ASSOCIATES OF ORADELL, LLC | 200626574 - (NJ) SURGICARE SURGICAL ASSOCIATES OF ORADELL LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $400.00 | 1205859550 - COMMUNITY SURGERY & LASER CENTER, LLC | 204589384 - (PA) COMMUNITY SURGERY LASER CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $7400.00 | 1609051515 - INDIANA ENDOSCOPY CENTERS LLC, INDIANA ENDOSCOPY CENTER | 208398421 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $535.00 | 1023373628 - EYES ON STARK SURGERY CENTER, LLC, VISTA SURGICAL CENTER | 451114025 - (OH) EYES ON STARK SURGERY CENTER, LLC DBA VISTA SURGICAL CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $750.00 | 1760465207 - PLASTIC SURGICAL CENTER OF RAPID CITY, PROF. L.L.C. | 460441899 - (SD) PLASTIC SURGICAL CENTER OF RAPID CITY PROF LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1039.00 | 1053366930 - ADVANCED SURGERY CENTER, LLC | 342045695 - (NE) ADVANCED SURGERY CENTER, LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $773.00 | 1346988870 - E-ASC LLC, BEACON EVENDALE SURGICAL CENTER | 882263306 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1274.00 | 1447797105 - SOUTH DENVER MUSCULOSKELETAL SURGICAL PARTNERS, LLC, SOUTH DENVER SURGERY CENTER | 364821257 - (CO) SOUTH DENVER MUSCULOSKELETAL SURGICAL PARTNERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1064.00 | 1811433410 - OPHTHALMOLOGY SURGERY CENTER OF ORLANDO LLC, ORLANDO OPHTHALMOLOGY SURGERY CENTER | 814378043 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1275.00 | 1730603622 - DULUTH SURGICAL SUITES LLC | 820668583 - (MN) DULUTH SURGICAL SUITES LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $530.00 | 1699767210 - SOUTHERN OKLAHOMA SURGICAL CENTER INC | 731205988 - (OK) SOUTHERN OKLAHOMA SURGICAL CENTER, INC. | OK | 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 63086 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 63086 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 63086 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 |
|---|---|---|
| 63085-CPT | High | Vertebral Corpectomy (Vertebral Body Resection), Partial Or Complete, Transthoracic Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Thoracic, Single Segment |
| 63086-CPT | Moderate | Vertebral Corpectomy (Vertebral Body Resection), Partial Or Complete, Transthoracic Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Thoracic, Each Additional Segment (List Separately In Addition To Code For Primary Procedure) |
| 63087-CPT | High | Vertebral Corpectomy (Vertebral Body Resection), Partial Or Complete, Combined Thoracolumbar Approach With Decompression Of Spinal Cord, Cauda Equina Or Nerve Root(S), Lower Thoracic Or Lumbar; Single Segment |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 63086. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 63086 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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