CPT 69511 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Auditory System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
National average reimbursement for CPT 69511 by major payers:
$1,595.13
$1,589.37
$1,663.66
$2,078.64
| 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 69511 | ||||||
United | 69511 | $3131.00 | 1346508520 - FIRST GI ENDOSCOPY AND SURGERY CENTER LLC | 270870899 - (NJ) FIRST GI ENDOSCOPY AND SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $1050.00 | 1598270951 - ARIZONA SURGICAL SPECIALISTS CENTER, LLC, NORTH PHOENIX ASSOCIATES | 760737449 - (AZ) ARIZONA SURGICAL SPECIALISTS CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $586.00 | 1528035367 - EYE SURGERY CENTER OF WESTERN OHIO LLC, EYE SURGERY CENTER OF WESTERN OHIO | 311570796 - (OH) EYE SURGERY CENTER OF WESTERN OHIO LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $2035.00 | 1578593224 - K S MANAGEMENT SERVICES LLC, KELSEY-SEYBOLD ASC | 842241460 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $1530.00 | 1023115078 - MAIN LINE PA ENDOSCOPY ASC LP, MAIN LINE ENDOSCOPY CENTER MALVERN | 205301211 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $2548.00 | 1922003052 - EAST OREGON SURGERY CENTER, LLC | 200209992 - (OR) EAST OREGON SUREGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $1874.00 | 1487655627 - UNION PINES SURGERY CENTER,LLC | 731622427 - (OK) UNION PINES SURGERY CENTER, LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $1523.50 | 1962695122 - NORTH ORANGE COUNTY SURGERY CENTER | 260625103 - (CA) NORTH ORANGE COUNTY SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $3422.00 | 1639452444 - CHILDREN'S AMBULATORY SURGERY CENTER OF NEW JERSEY, LLC | 271462884 - (NJ) CHILDRENS AMBULATORY SURGERY CENTER OF NEW JERSEY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $1786.00 | 1336366442 - CASTLE HILLS OUTPATIENT CENTER, INC., SURGICAL ARTS CENTER | 742931255 - (TX) CASTLE HILLS OUTPATIENT CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $830.00 | 1649233719 - GI ASC LLC | 861122720 - (PA) GI ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $854.00 | 1720023690 - BLUE WATER ASC LLC, BLUE WATER SURGERY CENTER, LLC | 383684085 - (MI) BLUE WATER ASC LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $1374.00 | 1063466118 - VALLEY SURGICAL CENTER INC | 204211574 - (PA) VALLEY SURGICAL CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $2447.00 | 1306957485 - FAIRFAX COLON & RECTAL SURGERY CENTER, LLC | 510571797 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69511 | $5008.00 | 1508978990 - WOODBRIDGE CENTER LLC, ENDOSCOPY AND SURGERY CENTER AT WOODBRIDGE HILLS | 30553583 - (MI) WOODBRIDGE CENTER LLC | MI | 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 69511 vs. Other Surgical Procedures on the Auditory System Codes
The CPT 69511 code is part of the Surgery services used for Surgical Procedures on the Auditory 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 69511 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 69511. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 69511 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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