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See a sample rate comparisonCPT 63197 Fee Schedule
Last Verified: September 2026
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.
Surgery On The Spinal Nerves, Surgery To Remove One Or More Bones Of The Spine (Vertebrae) And Disable Nerves In The Spinal Cord That Transmit Pain Signals To The Brain.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Nervous System |
| Common Place of Service | 21 - Inpatient Hospital |
| Common Modifiers | None AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 63197 |
| Medicaid Fee Schedule | View Medicaid rates for 63197 |
National average reimbursement for CPT 63197 by major payers:
$2,099.87
$2,285.51
$2,349.48
$2,773.08
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CPT 63197
5 of 25 sample ratesHigher to lower in this preview
Crown Point Surgical Suites, LLC
Crown Point Surgical Suites LLC
$2,831.00Published rateSacred Heart Asc, LLC
Sacred Heart Asc LLC
$840.00Published rateNephrology & Endocrine Associates Inc
$628.00Published rateSurgery Center 121 LLC
$390.00Published rateArizona Digestive Center, P.C.
Arizona Digestive Center PC
$90.00Published rate
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See a sample payer proposalCPT 63197 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 63197 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 63197 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 |
|---|---|---|
| 63191-CPT | High | Surgery To Cut Spinal Nerves, Surgery To Remove One Or More Bones Of The Spine (Vertebrae) And Sever Nerves In The Spinal Cord. This Procedure Relieves Muscle Spasm And Pain. |
| 63197-CPT | High | Surgery On The Spinal Nerves, Surgery To Remove One Or More Bones Of The Spine (Vertebrae) And Disable Nerves In The Spinal Cord That Transmit Pain Signals To The Brain. |
| 63200-CPT | High | Remove Scar Tissue On Spine, Removal Of A Portion Of Vertebra (Spine) And Surgery To Remove Adhesions (Scar Tissue) On The Spinal Cord. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 63197. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 63197 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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