CPT 64561 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 50 - Bilateral Procedure • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 64561 by major payers:
$994.04
$1,172.67
$1,187.79
$1,335.04
| 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 64561 | ||||||
United | 64561 | $14780.00 | 1609927748 - TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO | 752770738 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO | TX | General Acute Care Hospital (282N00000X) |
United | 64561 | $1679.00 | 1285835561 - BIENVILLE MEDICAL CENTER INC | 743227578 | LA | Critical Access Hospital (282NC0060X) |
United | 64561 | $14780.00 | 1598880940 - HARRIS METHODIST SOUTHWEST | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | General Acute Care Hospital (282N00000X) |
United | 64561 | $2873.79 | 1740644665 - WILLIAM ENSMINGER | 720700507 - (LA) ORTHOPAEDIC CLINIC OF MONROE, AMC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 64561 | $3475.00 | 1497090740 - OLOL PONTCHARTRAIN SURGERY CENTER, LLC, OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER | 461379031 - (LA) OLOL PONTCHARTRAIN SURGERY CENTE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64561 | $7830.08 | 1104057694 - SPECIALISTS HOSPITAL SHREVEPORT, LLC | 208810573 - (LA) SPECIALISTS HOSPITAL SHREVEPORT, L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | 64561 | $4437.00 | 1568454403 - DEAF SMITH COUNTY HOSPITAL DISTRICT, HEREFORD REGIONAL MEDICAL CENTER | 756001297 | TX | General Acute Care Hospital (282N00000X) |
United | 64561 | $4932.81 | 1275506115 - SPRINGHILL MEDICAL SERVICES, INC., SPRINGHILL MEDICAL CENTER | 721479692 - SPRINGHILL MEDICAL SERVICES INC | LA | General Acute Care Hospital (282N00000X) |
United | 64561 | $1702.70 | 1689612954 - SWEDISH HEALTH SERVICES | 911942315 | WA | Multi-Specialty Group (193200000X) |
United | 64561 | $7214.00 | 1619115383 - ASCENSION SETON, ASCENSION SETON HAYS | 741109643 - ASCENSION SETON | TX | General Acute Care Hospital (282N00000X) |
United | 64561 | $774.72 | 1356055016 - BELUGA HEALTH PC | 921535934 - BELUGA HEALTH PC | WA | Multi-Specialty Clinic/Center (261QM1300X) |
United | 64561 | $1277.10 | 1023332749 - PUBLIC HOSPITAL DIST NO 1 SKAGIT, SKAGIT REGIONAL HEALTH | 562392010 | WA | Multi-Specialty Group (193200000X) |
United | 64561 | $1484.26 | 1043215809 - BYRON RUSSELL | 860332291 - (AZ) SCOTTSDALE UROLOGIC SURGEONS, LTD. | WA | Urology Physician (208800000X) |
United | 64561 | $7352.00 | 1548236524 - NORTH CENTRAL SURGICAL CENTER L.L.P. | 201508140 - (TX) NORTH CENTRAL SURGICAL CENTER LLP | TX | General Acute Care Hospital (282N00000X) |
United | 64561 | $14780.00 | 1215296884 - TEXAS HEALTH HARRIS METHODIST HOSPITAL ALLIANCE | 451502252 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL ALLIANCE | TX | General Acute Care Hospital (282N00000X) |
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 64561 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 64561 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 64561 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 |
|---|---|---|
| 64486 | Low | Transversus Abdominis Plane (Tap) Block (Abdominal Plane Block, Rectus Sheath Block) Unilateral; By Injection(S) (Includes Imaging Guidance, When Performed) |
| 64553 | High | Implantation Of Cranial Nerve Neurostimulator Electrodes, Accessed Through The Skin |
| 64555 | High | Percutaneous Implantation Of Neurostimulator Electrodes Array; Peripheral Nerve (Excludes Sacral Nerve) |
| 64561 | Moderate | Percutaneous Implantation Of Neurostimulator Electrode Array; Sacral Nerve (Transforminal Placement)Including Image Guidance If Performed (Revised 1/1/2013) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 64561. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 64561 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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