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 |
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 | $4449.00 | 1861405607 - CEDAR PARK SURGERY CENTER LLP, HILL COUNTRY AMBULATORY SURGERY CENTER | 202829728 - (TX) CEDAR PARK SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $3240.00 | 1760465207 - PLASTIC SURGICAL CENTER OF RAPID CITY, PROF. L.L.C. | 460441899 - (SD) PLASTIC SURGICAL CENTER OF RAPID CITY PROF LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $3878.00 | 1235155730 - MONTPELIER SURGERY CENTER | 770548811 - (CA) MONTPELIER SURGERY CENTER | CA | 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 | $1523.00 | 1760020846 - FOUNDERS SURGERY CENTER, LLC | 843861807 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $13726.00 | 1831238773 - CORPUS CHRISTI ENDOSCOPY CENTER LLP, CORPUS CHRISTI ENDOSCOPY CENTER | 202595593 - (TX) CORPUS CHRISTI ENDOSCOPY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $6588.00 | 1861071250 - ADVENTHEALTH SURGERY CENTER MILLS PARK LLC, ADVENTHEALTH SURGERY CENTER MILLS PARK | 832780608 - (FL) ADVENTHEALTH SURGERY CENTER MILLS PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $1326.00 | 1720081870 - ORTHOPAEDIC AMBULATORY SURGICAL INTERVENTION SERVICES, LLC, OASIS | 582398485 - (OH) ORTHOPAEDIC AMBULATORY SURGICAL INTERVENTION SERVICES, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $3275.00 | 1194323725 - MISSION SURGERY CENTER LLC | 853429411 - (TX) MISSION SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $1007.00 | 1558327445 - MERCY AMBULATORY SURGERY CENTER LTD | 631178796 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $6588.00 | 1649223124 - CAMP LOWELL SURGERY CENTER,LLC, CAMP LOWELL SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $6087.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $1900.00 | 1841039443 - PACIFIC GASTRO HEALTH PLLC, PACIFIC GASTRO HEALTH | 201377401 - (WA) PACIFIC GASTROENTEROLOGY, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $9345.00 | 1891730644 - LAKEWALK SURGERY CENTER, INC. | 411791860 - (MN) LAKEWALK SURGERY CENTER INC. | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 64628 | $6224.00 | 1043275183 - FOREST AMBULATORY SURGICAL ASSOCIATES LLC, FOREST SURGERY CENTER | 942934248 - (CA) FOREST AMBULATORY SURGICAL ASSOCIATES, LP | CA | 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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