CPT 63268 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 • 58 - Staged or related procedure during postoperative period • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
National average reimbursement for CPT 63268 by major payers:
$1,679.37
$1,925.30
$1,998.46
$2,364.07
| 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 63268 | ||||||
United | 63268 | $1691.00 | 1306958103 - NEI AMBULATORY SURGERY CENTER INC PC | 232429169 - (PA) NEI AMBULATORY SURGERY CENTER INC PC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $1926.00 | 1124099635 - HUNTINGTON SURGERY CENTER LIMITED PARTNERSHIP, CABELL HUNTINGTON SURGERY CENTER | 550647724 - (WV) CABELL HUNTINGTON SURGERY CENTER | WV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $10000.00 | 1962815746 - CAPITOL STREET SURGERY CENTER LLC | 465061657 - (IN) CAPITOL STREET SURGERY CENTER LL | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $6492.00 | 1891298089 - MICHIGAN OUTPATIENT SURGICAL SOLUTIONS, LLC | 821706937 - (MI) MICHIGAN OUTPATIENT SURGICAL SOLUTIONS LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $3000.00 | 1174634778 - THE CENTER FOR SPECIALIZED SURGERY, LP | 203364256 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $900.00 | 1598189342 - MEI SURGERY CENTER LLC, MICHIGAN EYE SURGERY CENTER | 461591012 - (MI) MEI SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $3316.00 | 1275522849 - COLIMA ENDOSCOPY CENTER INC, COLIMA ENDOSCOPY CENTER | 954611492 - (CA) COLIMA ENDOSCOPY CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $3301.00 | 1033181862 - EL PASO ASC LP, ENDOSCOPY CENTER OF EL PASO | 621731682 - (TX) EL PASO ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $2704.00 | 1235768490 - HENRY'S FORK SURGERY CENTER PLLC | 850508190 - (ID) HENRYS FORK SURGERY CENTER PLLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $3671.00 | 1164852455 - NURA SURGICAL CENTER LLC, MINNEAPOLIS PAIN CENTERS LLC | 901026241 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $3800.00 | 1154839678 - R&R SURGICAL INSTITUTE | 820815470 - (CA) RR SURGICAL INSTITUTE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $3562.00 | 1649208679 - AKRON SURGICAL ASSOCIATES, LLC, THE SURGERY CENTER AT AKRON GENERAL HEALTH & WELLNESS CENTER | 10672877 - (OH) AKRON SURGICAL ASSOCIATES LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $1490.00 | 1477628725 - SURGERY & LASER CENTER AT PROFESSIONAL PARK LLC, SURGERY & LASER CENTER AT PROFESSIONAL PARK LLC | 202435770 - (SC) SURGERY LASER CENTER AT PROFESSIONAL PARK LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $6492.00 | 1104181247 - ADVANCED SURGERY CENTER OF NORTHERN LOUISIANA LLC | 455502071 - (LA) ADVANCED SURGERY CENTER OF NORTHERN LOUISIANA, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 63268 | $28000.00 | 1720127483 - FRONT RANGE ORTHOPEDIC SURGERY CENTER LLC | 311728173 - (CO) FRONT RANGE ORTHOPEDIC SURGERY CENTER LLC | CO | 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 63268 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 63268 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 63268 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 |
|---|---|---|
| 63268-CPT | High | Exc Les Intraspin Extradur-Sacral |
| 63273-CPT | High | Exc Les Intraspin Intradur-Sacral |
| 63278-CPT | High | Exc Intraspin Neopl Extradur-Sacral |
| 63295-CPT | Moderate | Osteoplastic Reconstruction Of Dorsal Spinal Elements, Following Primary Intraspinal Procedure (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 63268. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 63268 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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