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See a sample rate comparisonCPT 64861 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Neurorrhaphy Brachial Plexus
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Nervous System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 64861 |
| Medicaid Fee Schedule | View Medicaid rates for 64861 |
National average reimbursement for CPT 64861 by major payers:
$2,125.90
$1,975.18
$2,004.25
$2,358.66
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CPT 64861
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Katy LLP
$6,904.00Published rateNorcal Orthopedic Surgery Center, LLC
Norcal Orthopedic Surgery Center LLC
$3,244.00Published rateGold Coast Surgicenter, LLC
$1,900.00Published rateBaptist Germantown Surgery Center, LLC, Baptist Germantown Surgery Center
Baptist Germantown Surgery Center LLC
$1,500.00Published rateIdox3 LLC, Tri-State Surgery Center
Idox3 LLC
$1,000.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 64861 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 64861 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 64861 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 64861. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 64861 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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