CPT 64425 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 • 59 - Distinct Procedural Service • 50 - Bilateral Procedure |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 64425 |
National average reimbursement for CPT 64425 by major payers:
$149.54
$164.23
$175.52
$200.66
| 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 64425 | ||||||
United | 64425 | $516.00 | 1831238773 - CORPUS CHRISTI ENDOSCOPY CENTER LLP, CORPUS CHRISTI ENDOSCOPY CENTER | 202595593 - (TX) CORPUS CHRISTI ENDOSCOPY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $934.00 | 1114196151 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $367.00 | 1225075435 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE SURGICENTER-COTTONWOOD | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $962.00 | 1619149960 - THE VANCOUVER CLINIC INC PS, THE VANCOUVER CLINIC, AMBULATORY SURGERY CENTER | 910851599 - THE VANCOUVER CLINIC, INC., PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $300.00 | 1639237092 - MUSCULOSKELETAL AMBULATORY SURGERY CENTER INC, THE SURGERY CENTER AT POINTE WEST | 650829385 - (FL) MUSCULOSKELETAL AMBULATORY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $400.00 | 1033468442 - CORNERSTONE SURGICARE LLC | 460563529 - (FL) CORNERSTONE SURGICARE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $207.00 | 1669668943 - POOLE ENDOSCOPY CENTER, NEEL KAMAL MD | 521831316 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $364.00 | 1578722633 - GREENVILLE SURGERY CENTER LP, PIEDMONT SURGERY CENTER | 570965527 - (SC) GREENVILLE SURGERY CENTER LIMITED PARTNERSHIP | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $390.00 | 1396266441 - EYE SURGERY CENTER OF EAST TEXAS LLC | 811881035 - (TX) EYE SURGERY CENTER OF EAST TEXAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $244.13 | 1457597197 - DEACONESS HOSPITAL, INC | 350593390 - DEACONESS HOSPITAL INC | IN | Surgery Physician (208600000X) |
United | 64425 | $1838.95 | 1043094527 - WAUKEE SURGERY CENTER LLC | 881808321 - (IA) WAUKEE SURGERY CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $953.00 | 1396211264 - PALM BEACH SURGICAL SUITES LLC | 830558319 - (FL) PALM BEACH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $254.00 | 1043268840 - PREMIERE SURGERY CENTER, INC | 330420108 - (CA) PREMIERE SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $580.00 | 1881690949 - ADVANCED AMBULATORY SURGERY CENTER LP | 731675692 - (CA) ADVANCED AMBULATORY SURGERY | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64425 | $1145.00 | 1790798668 - UNIVERSITY HOSPITALS MANAGEMENT SERVICES ORGANIZATION INC, UHHS WESTLAKE SURGERY CENTER | 341567805 - UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | 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 64425 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 64425 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 64425 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 |
|---|---|---|
| 64420-CPT | Low | Injection(S) Anesthetic Agent(S) And/Or Steroid; Intercostal Nerve Single Level (Desc Rvsd 1/1/20) |
| 64425-CPT | Low | Injection(S) Anesthetic Agent(S) And/Or Steroid; Ilioinguinal Iliohypogastric Nerves (Desc Rvsd 1/1/20) |
| 64450-CPT | Low | Injection(S) Anesthetic Agent(S) And/Or Steroid; Other Peripheral Nerve Or Branch (Desc Rvsd 1/1/20) |
| 64451-CPT | Moderate | Injection(S) Anesthetic Agent(S) And/Or Steroid; Nerves Innervating The Sacroiliac Joint With Image Guidance (Ie Fluoroscopy Or Computed Tomography) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 64425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 64425 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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