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 |
| Medicare Fee Schedule | View Medicare rates for 64405 |
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 | $1325.00 | 1245657840 - SURGCENTER OF PLANO LLC | 462873916 - (TX) SURGCENTER OF PLANO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $688.00 | 1114196151 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $574.00 | 1588610190 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $200.00 | 1609223056 - HEART HEALTH CENTER, LLC | 473280746 - (AZ) HEART HEALTH CENTER LLC | AZ | 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 | $54.00 | 1750974176 - NCBH OUTPATIENT ENDOSCOPY CENTER, L.L.C., WAKE FOREST BAPTIST HEALTH OUTPATIENT ENDOSCOPY - QUAKER LANE | 270668137 - (NC) NCBH OUTPATIENT ENDOSCOPY CENTER LLC | NC | 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 | $201.00 | 1750036174 - GLACIER SURGICAL INC. | 861271667 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $464.60 | 1740442615 - CENTER FOR ADVANCED REPRODUCTIVE SERVICES, PC, AMBULATORY SURGICAL CENTER AT REPRODUCTIVE SERVICES | 61522659 - (CT) CENTER FOR ADVANCED REPRODUCTIVE SERVICES, P.C. | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $138.00 | 1619970472 - CYPRESS OUTPATIENT SURGICAL CENTER, INC. | 770173551 - (CA) CYPRESS OUTPATIENT SURGICAL CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $105.00 | 1013048461 - GASTROENTEROLOGY DIAGNOSTIC CENTER MEDICAL GROUP, A PROFESSIONAL, GASTROENTEROLOGY DIAGNOSTIC CENTER | 953921090 - (CA) GASTROENTEROLOGY DIAGNOSTIC CENTER MEDICAL GROUP A PROFESSIONAL | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $555.00 | 1083624670 - PRESCOTT OUTPATIENT SURGICAL CENTER LLC | 860548048 - (AZ) PRESCOTT OUTPATIENT SURGICAL CENTER, LP | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64405 | $228.00 | 1164852455 - NURA SURGICAL CENTER LLC, MINNEAPOLIS PAIN CENTERS LLC | 901026241 | MN | 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 | $323.00 | 1841259611 - ALTA-ROSE SURGERY CENTER LLC | 201429557 | NV | 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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