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See a sample rate comparisonCPT 64405 Fee Schedule
CPT 64405 is classified under Surgery, in the Surgical Procedures on the Nervous System subgroup.
Njx Aa&/Strd Gr Ocpl Nrv, Injection Of Anesthetic Agent And/Or Steroid Into Greater Occipital Nerve Of Upper Neck And Back Of Head
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Nervous System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | 50Bilateral Procedure 59Distinct Procedural Service |
| Hospital Outpatient Group (APC) | APC 5441 - Level 1 Nerve Injections |
| Surgery Center Payment (ASC) | P3 - Office-based; paid from physician fee schedule practice expense |
| Add-on Codes | 77002 |
| Common Revenue Codes | 04500361Sign up to view all 14 |
| Medicare Fee Schedule | View Medicare rates for 64405 |
| Medicaid Fee Schedule | $62.20 median of the 8 states in the free previewView Medicaid rates for 64405 |
National average reimbursement for CPT 64405 by major payers:
$116.76
BCBS / Anthem
$118.41
UnitedHealthcare
$129.50
Aetna
$101.19
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 64405.
CPT 64405
5 of 25 sample ratesHigher to lower in this preview
Atlantic Gastro Surgicenter, LLC, T/A Access
Atlantic Gastro Surgicenter LLC
$1,708.00Published ratePrescott Outpatient Surgical Center LLC
Prescott Outpatient Surgical Center, Lp
$555.00Published ratePhoenix Orthopaedic Ambulatory Center, LLC, Gateway Surgery Center
Phoenix Orthopaedic Ambulatory Center, LLC
$230.00Published rateLos Angeles-Inglewood Endoscopy Lp, Airport Endoscopy Center
Los Angelesinglewood Endoscopy Lp
$144.00Published rateNcbh Outpatient Endoscopy Center, L.L.C., Wake Forest Baptist Health Outpatient Endoscopy - Quaker Lane
Ncbh Outpatient Endoscopy Center LLC
$54.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 64405 vs. Other Surgical Procedures on the Nervous System Codes
The table lists codes related to 64405. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 64400-CPT | Njx Aa Strd Trigeminal Nrv, Injection S Anesthetic Agent S And Or Steroid Trigeminal Nerve Each Branch Ie Ophthalmic Maxillary Mandibular |
| 64405-CPT | Njx Aa&/Strd Gr Ocpl Nrv, Injection Of Anesthetic Agent And/Or Steroid Into Greater Occipital Nerve Of Upper Neck And Back Of Head |
| 64408-CPT | Inject Nerve For Pain Control, Injection Of Anesthetic Or Other Medicine Into A Nerve To Relieve Pain. |
| 64415-CPT | Injection Aa&/Strd Brachial Plexus W/Img Gdn, Injection(S) Anesthetic Agent(S) And/Or Steroid; Brachial Plexus Including Imaging Guidance When Performed |
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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Frequently Asked Questions
What is a healthcare fee schedule?
A healthcare fee schedule is a comprehensive listing of fees that health insurers, including government programs and commercial payers, use to reimburse healthcare providers for specific medical services, procedures, and supplies. These schedules are typically based on Current Procedural Terminology (CPT) codes and can vary significantly depending on the payer, geographic location, and specific service rendered.
Where can I find fee schedules for healthcare services?
Fee schedules are largely proprietary to individual health insurance payers. While general Medicare fee schedules are publicly available through CMS, for specific fee schedules relevant to commercial payers or your unique situation, you would need to consult individual payers. For a convenient way to look up fee schedules for various payers based on CPT code and specific location, it is recommended to use a specialized tool like Payerprice.
What is the difference between Payerprice and CMS for looking up fee schedules?
CMS (Centers for Medicare & Medicaid Services) provides fee schedules primarily for Medicare and Medicaid services, which are often publicly accessible and specific to government-funded programs. Payerprice, on the other hand, offers a fee schedule lookup tool designed to help users search for fee information from a variety of commercial health insurance payers. This allows users to find more specific and diverse fee data beyond just Medicare, tailored to CPT codes and specific locations for their particular situation.
How can I look up a fee schedule for a specific CPT code and location?
To accurately look up a fee schedule for a specific CPT code and geographic location, it is recommended to use a specialized tool. Payerprice offers a fee schedule lookup tool that allows users to search by CPT code and specific location to find relevant fee information from various commercial payers. This helps in understanding potential reimbursement rates for your specific situation.
Is there a tool available to easily search for fee schedules across different commercial payers?
Yes, for easily searching fee schedules across different commercial payers for your specific situation, Payerprice provides a fee schedule lookup tool. This tool allows users to input a CPT code and a specific location to retrieve relevant fee information, helping to streamline the process of understanding expected reimbursements from a variety of health insurance plans.
What APC is CPT 64405 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 64405 to APC 5441 (Level 1 Nerve Injections). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 64405 in an ambulatory surgery center?
CMS lists CPT 64405 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which add-on codes are billed with CPT 64405?
CMS add-on code edits list CPT 64405 as a primary code for these add-on codes: 77002.
Which revenue codes are billed with CPT 64405?
Hospital price transparency files list CPT 64405 under these revenue codes: including 0450, 0361, 0761, 0360 and 0510. A revenue code names the hospital department or charge category for the line; it does not change what the service is.