CPT 64628 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 • KX - Requirements specified in the medical policy have been met • SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 64628 |
National average reimbursement for CPT 64628 by major payers:
$544.60
$658.76
$641.89
$775.11
| 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 64628 | ||||||
United | 64628 | $749.84 | 1104890052 - MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER, LLC, MID-STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER INC | 721310991 - (LA) MIDSTATE ORTHOPAEDIC & SPORTS MEDICINE CENTER, INC. | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 64628 | $6365.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $539.10 | 1073513826 - DAVID MULDOWNY | 721331195 - (LA) DAVID S MULDOWNY MD APMC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 64628 | $9959.80 | 1124170691 - WILLIS KNIGHTON MEDICAL CENTER, INC., WILLIS KNIGHTON SOUTH HOSPITAL | 720400933 - (LA) WILLIS-KNIGHTON MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | 64628 | $16083.00 | 1598880940 - HARRIS METHODIST SOUTHWEST | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | General Acute Care Hospital (282N00000X) |
United | 64628 | $1826.00 | 1134366370 - CENTER OF SURGICAL EXCELLENCE, COSE ANESTHESIA BILLING | 202807874 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $2386.00 | 1295906956 - THE ENT CENTER OF RHODE ISLAND LLC, THE SURGERY CENTER OF RHODE ISLAND | 260329297 - (RI) THE ENT CENTER OF RHODE ISLAND | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $1230.00 | 1740251909 - NORTH FLORIDA GI CENTER LTD, HCA FLORIDA NORTH FLORIDA ENDOSCOPY CENTER | 621727350 - (FL) NORTH FLORIDA GI CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $492.20 | 1447544465 - CHARLES SCHUMACHER | 463936183 - (LA) LMG, LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 64628 | $607.96 | 1811991714 - EDWARD ANGLIN | 720703150 - HIGHLAND CLINIC, APMC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 64628 | $367.57 | 1649223645 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, ROUND ROCK MEDICAL CENTER | 743001674 - (TX) LONE STAR CIRCLE OF CARE | TX | General Acute Care Hospital (282N00000X) |
United | 64628 | $478.88 | 1730171299 - EUBULUS KERR | 320353742 - (LA) SPINE INSTITUTE OF LOUISIANA, LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 64628 | $3325.00 | 1255911970 - PINNACLE SURGERY CENTER | 842367400 - (LA) PINNACLE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $11320.00 | 1598744856 - VHS SAN ANTONIO PARTNERS LLC, BAPTIST MEDICAL CENTER | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 64628 | $2588.00 | 1689633588 - SOUTH JERSEY ENDOSCOPY LLC, DIMARINO-KROOP-PRIETO GI ASSOC | 200478348 - (NJ) SOUTH JERSEY ENDOSCOPY LLC | NJ | 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 64628 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 64628 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 64628 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 |
|---|---|---|
| 64628-CPT | Moderate | Thermal Destruction Of Intraosseous Basivertebral Nerve, Including All Imaging Guidance; First 2 Vertebral Bodies, Lumbar Or Sacral - Deny Inv/N10 |
| 64629-CPT | Moderate | Thermal Destruction Of Intraosseous Basivertebral Nerve Including All Imaging Guidance; Each Additional Vertebral Body Lumbar Or Sacral (List Separately In Addition To Code For Primary Pro- Cedure) |
| 64633-CPT | Moderate | Once Per Dos Destruction By Neurolytic Agent, Paravertebral Facet Joint Nerve W/Imaging Guidance; Cervical Or Thoracic, Single Facet Joint- Medicaid Rn Review>=7/8/2017 |
| 64634-CPT | Moderate | Destruction By Neurolytic Agent Paravertebral Facet Joint Nerve(S) With Imaging Guidance Fluoroscopy Or Ct); Cervical Or Thoracic Each Additional Facet Joint (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 64628. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 64628 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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