CPT 64491 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 | • 24 - Ambulatory Surgical Center • 11 - Office |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Low |
National average reimbursement for CPT 64491 by major payers:
$122.71
$137.81
$140.84
$170.48
| 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 64491 | ||||||
United | 64491 | $261.00 | 1538389812 - IRONBOUND ENDO SURGICAL CENTER, INC. | 223651393 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $108.00 | 1629576848 - CAROLINA INTERVENTIONAL PAIN INSTITUTE, LLC, CAROLINA INTERVENTIONAL PAIN INSTITUTE, LLC | 822281290 - (SC) CAROLINA INTERVENTIONAL PAIN INSTITUTE LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $574.00 | 1538390539 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $290.00 | 1659525020 - GLASTONBURY ENDOSCOPY CENTER, LLC | 261721234 - (CT) GLASTONBURY ENDOSCOPY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $263.00 | 1811228083 - MESQUITE SURGERY CENTER LLC | 270170010 - (AZ) MESQUITE SURGERY CENTER, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $396.00 | 1962506618 - THE POLYCLINIC, ASC POLYCLINIC SURGERY CENTER | 910369070 - (WA) THE POLYCLINIC, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $240.00 | 1295918977 - WEST COAST CENTERS FOR SURGERIES LLC | 261572011 - (CA) WEST COAST CENTERS FOR SURGERIES LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $79.00 | 1619487782 - UCH VASCULAR ACCESS ASC LLC | 820975009 - (TN) UCH VASCULAR ACCESS ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $128.00 | 1306274097 - INTERVENTIONAL PAIN MANAGEMENT LLC | 452192531 - (IN) INTERVENTIONAL PAIN MANAGEMENT LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $64.00 | 1821093204 - LAUREL LASER & SURGERY CENTER, L.P. | 251852464 - (PA) LAUREL LASER SURGERY CENTER LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $166.86 | 1841228822 - DEACONESS HOSPITAL, INC, <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 64491 | $274.00 | 1104373315 - BRENTWOOD SURGERY CENTER, LLC, BRENTWOOD SURGERY CENTER | 200533890 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $645.00 | 1649269663 - PHYSICIANS ALLIANCE LC, PHYSICIANS ALLIANCE SURGERY CENTER | 431832038 - (MO) PHYSICIANS ALLIANCE LC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $300.00 | 1225523970 - BURNSVILLE SURGERY CENTER, P.A. | 830965169 - (MN) BURNSVILLE SURGERY CENTER PA | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64491 | $688.00 | 1932735677 - PARKCREEK ASC LLC | 843082809 | FL | 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 64491 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 64491 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 64491 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 |
|---|---|---|
| 64490-CPT | Moderate | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Image Guidance (Flouroscopy Or Ct) Cervical Or Thoracicsingle Level |
| 64491-CPT | Low | Injection(S), Diagnostic Or Therapeutic Agent, Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Image Guidance (Fluoroscopy Or Ct), Cervical Or Thoracic; Second Level (List Separately In Addition To Code For Primary Procedure) |
| 64492-CPT | Low | Injection(S), Diagnostic Or Therapeutic Agent, Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Image Guidance (Fluoroscopy Or Ct), Cervical Or Thoracic; Third And Any Additional Level(S) (List Separately In Addition To Code For Pri |
| 64493-CPT | Moderate | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nervies Innervating That Joint) With Image Guidance (Flouroscopy Or Ct) Lumbar Or Sacral; Single Level |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 64491. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 64491 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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