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 |
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 | $1250.00 | 1780218115 - SURGERY CENTER OF FORT WAYNE | 825163478 - (IN) SURGERY CENTER OF FORT WAYNE LLC | IN | 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 | $6623.00 | 1164486809 - SAINT LUKE'S SURGICENTER | 470853481 - (MO) SAINT LUKES SURGICENTER | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1064.00 | 1114302353 - POINT OF ROCKS SURGERY CENTER, LLC | 464992977 - (MD) POINT OF ROCKS SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $492.00 | 1376115816 - BARNET DULANEY PERKINS EYE CENTER, PC, AMERICAN VISION PARTNERS | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $349.00 | 1902802036 - CATARACT & SURGICAL CENTER OF LUBBOCK LLC | 522344594 - (TX) CATARACT SURGICAL CENTER OF LUBBOCK LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $676.00 | 1922412790 - SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC, SENTARA KITTY HAWK AMBULATORY SURGERY CENTER | 463846081 - SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1856.00 | 1508197039 - FREEMAN SURGICAL CENTER LLC | 262652980 - (MO) FREEMAN SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $523.00 | 1508531641 - ALLIANCE SURGERY CENTER AT SANDY SPRINGS LLC | 871977629 - (GA) ALLIANCE SURGERY CENTER AT SANDY SPRINGS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $405.00 | 1386616050 - INDEPENDENCE ASC LLC, THE ENDOSCOPY CENTER - NORTH | 621707564 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $951.00 | 1629461934 - NORTHERN EC LLC | 464211412 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $2666.00 | 1689636219 - FLORIDA OUTPATIENT SURGERY CENTER LTD | 752457259 - (FL) FLORIDA OUTPATIENT SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1049.00 | 1861071250 - ADVENTHEALTH SURGERY CENTER MILLS PARK LLC, ADVENTHEALTH SURGERY CENTER MILLS PARK | 832780608 - (FL) ADVENTHEALTH SURGERY CENTER MILLS PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1913.00 | 1528104080 - SURGICAL CENTER AT CEDAR KNOLLS LLC | 202158771 - (NJ) SURGICAL CENTER AT CEDAR KNOLLS | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63086 | $1049.00 | 1295860302 - GOLD COAST SURGERY CENTER LLC, GULF COMPREHENSIVE SURGERY CENTER | 203958739 - (FL) GOLD COAST SURGERY CENTER LLC | FL | 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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