CPT 64454 Fee Schedule

Healthcare price transparency refers to the ability for consumers to access clear and understandable information about the cost of healthcare services before receiving care. The goal is to empower patients to make informed decisions and compare prices among different providers and plans.

Healthcare costs are often complex and difficult to determine upfront due to several factors, including the negotiation of different rates between insurers and providers, the bundling of services, varying deductibles and co-pays, and a lack of standardized, easily accessible pricing information for specific procedures across all payers and locations.

To find out the cost of a specific medical procedure, it's best to use tools designed for price lookup. For detailed, specific pricing based on CPT codes and your location, you can utilize Payerprice's fee schedule lookup tool. This tool allows you to search for negotiated rates, which can vary significantly depending on your specific situation.

CPT stands for Current Procedural Terminology. CPT codes are a standardized set of five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for understanding medical costs because they precisely identify the specific service or procedure performed, allowing for accurate billing and price lookups.

Payerprice provides a fee schedule lookup tool that allows users to search for specific negotiated rates using CPT codes and locations. These rates reflect commercial payer data, offering insights into actual prices charged to patients by various insurance companies. While CMS (Centers for Medicare & Medicaid Services) provides data related to Medicare and Medicaid reimbursement rates and some hospital price transparency files, Payerprice is specifically designed to give users access to commercial fee schedules and specific pricing based on their individual search criteria, making it more tailored for consumers looking for specific costs with their commercial insurance plans.

To use Payerprice's fee schedule lookup tool, you typically need to input the specific CPT code for the medical service or procedure you are interested in, along with your desired location. The tool will then provide you with relevant fee schedule information, helping you understand potential costs based on commercial payer data.

Payerprice's information is based on commercial fee schedules and is specific to the CPT codes and locations you search. While it provides valuable insights into negotiated rates, actual out-of-pocket costs can still vary based on your specific insurance plan (deductibles, co-pays, co-insurance), provider network status, and whether additional services are rendered. It's a powerful tool for estimating costs, but always confirm with your provider and insurer.

Medicare's hospital outpatient payment system (OPPS) assigns CPT 64454 to APC 5442 (Level 2 Nerve Injections). An APC groups outpatient services that Medicare pays at the same base rate.

CMS lists CPT 64454 with ASC payment indicator G2: Paid separately, from the OPPS relative weight.

Hospital price transparency files list CPT 64454 under these revenue codes: including 0361, 0360, 0761, 0510 and 0964. A revenue code names the hospital department or charge category for the line; it does not change what the service is.