CPT 64405 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 50 - Bilateral Procedure • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 64405 by major payers:
$116.76
$118.41
$129.50
$140.96
| 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 64405 | ||||||
United | 64405 | $220.00 | 1770114290 - NORTH SUBURBAN PAIN AND SPINE CENTER LLC | 824454412 - (IL) NORTH SUBURBAN PAIN & SPINE CENT | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $304.00 | 1508912262 - WAUKEGAN ILLINOIS HOSPITAL COMPANY LLC, VISTA SURGERY CENTER | 203978521 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $550.00 | 1942230024 - LUTHERVILLE ENDOSCOPY CENTER LLC | 823193901 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $1103.00 | 1669748125 - RIVERVIEW SURGERY CENTER LLC | 452951941 - (IN) RIVERVIEW SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $150.00 | 1265401202 - NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S., THE ORTHOPAEDIC SURGERY CENTER | 911502837 - NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $230.00 | 1336131143 - PHOENIX ORTHOPAEDIC AMBULATORY CENTER, LLC, GATEWAY SURGERY CENTER | 860970374 - (AZ) PHOENIX ORTHOPAEDIC AMBULATORY CENTER, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $252.00 | 1528274719 - LASER AND VISION SURGERY CENTER, LLC | 61553382 - (CT) LASER AND VISION SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $883.00 | 1801179619 - SURGICARE OF FREEHOLD LIMITED LIABILITY COMPANY | 273075822 - (NJ) SURGICARE OF FREEHOLD LIMITED LIABILITY COMPANY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $1301.00 | 1245798826 - SURGCENTER OF GREATER DALLAS, LLC., SURGCENTER OF GREATER DALLAS | 831498677 - (TX) SURGCENTER OF GREATER DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $121.00 | 1508839473 - NEWARK ENDOSCOPY ASC LLC, ENDOSCOPY CENTER OF DELAWARE | 621867825 - (DE) NEWARK ENDOSCOPY ASC LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $883.00 | 1801179619 - SURGICARE OF FREEHOLD LIMITED LIABILITY COMPANY | 273075822 - (NJ) SURGICARE OF FREEHOLD LIMITED LIABILITY COMPANY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $555.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $555.00 | 1952814386 - ADVANCED SURGICAL CARE OF BOERNE, LLC | 821680961 - (TX) ADVANCED SURGICAL CARE OF BOERNE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $1028.00 | 1659336881 - MT. OGDEN SURGICAL CENTER LLC | 371705271 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $312.00 | 1215178835 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | 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 64405 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 64405 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 64405 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 |
|---|---|---|
| 64400-CPT | Low | Injection(S) Anesthetic Agent(S) And/Or Steroid; Trigeminal Nerve Each Branch (Ie Ophthalmic Maxillary Mandibular) (Desc Rvsd 1/1/20) |
| 64405-CPT | Low | Injection Of Anesthetic Agent And/Or Steroid Into Greater Occipital Nerve Of Upper Neck And Back Of |
| 64408-CPT | Low | Injection(S) Anesthetic Agent(S) And/Or Steroid; Vagus Nerve (Desc Rvsd 1/1/20) |
| 64415-CPT | Low | Injection(S) Anesthetic Agent(S) And/Or Steroid; Brachial Plexus Including Imaging Guidance When Performed (Desc Rvsd 1/1/23) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 64405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 64405 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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