HCPCS C7516 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 | • Outpatient PPS • Miscellaneous Surgical Procedures |
| Complexity Level | High |
National average reimbursement for HCPCS C7516 by major payers:
$1,013.61
$N/A
$8,296.15
$N/A
| 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 HCPCS C7516 | ||||||
United | C7516 | $1762.00 | 1336568187 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA INTEGRATED HEALTH | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
United | C7516 | $3100.00 | 1285688234 - FAIRVIEW PARK, LIMITED PARTNERSHIP, FAIRVIEW PARK HOSPITAL | 621817469 - (GA) FAIRVIEW PARK LIMITED PARTNERSHIP | GA | General Acute Care Hospital (282N00000X) |
United | C7516 | $16885.00 | 1417554528 - KECK MEDICAL CENTER OF USC | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | General Acute Care Hospital (282N00000X) |
United | C7516 | $560.00 | 1932977360 - SCB SURGERY CENTER LLC, LOUISIANA SURGERY CENTER | 882035944 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7516 | $1762.00 | 1427476670 - MARICOPA COUNTY SPECIAL HEALTHCARE DISTRICT, MARICOPA INTEGRATED HEALTH | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
United | C7516 | $1514.00 | 1003273855 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA SPECIAL HEALTH CARE DISTRICT | 860830701 | AZ | Adult Mental Health Clinic/Center (261QM0850X) |
United | C7516 | $1762.00 | 1851145809 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT | 860830701 | AZ | Adult Mental Health Clinic/Center (261QM0850X) |
United | C7516 | $1514.00 | 1861811614 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA INTEGRATED HEALTH | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
United | C7516 | $13097.00 | 1093009151 - USC UNIVERSITY HOSPITAL | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | General Acute Care Hospital (282N00000X) |
United | C7516 | $1514.00 | 1104331115 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE CHC - MESA BEHAVIORAL HEALTH SPECIALTY CLINIC | 860830701 | AZ | Adult Mental Health Clinic/Center (261QM0850X) |
United | C7516 | $7487.00 | 1750358297 - CITY OF HOPE NATIONAL MEDICAL CENTER | 951683875 - CITY OF HOPE NATIONAL MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | C7516 | $1514.00 | 1770167108 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT | 860830701 | AZ | Multi-Specialty Clinic/Center (261QM1300X) |
United | C7516 | $300.00 | 1548233794 - METAIRIE OPHTHALMOLOGY ASC LLC, AMBULATORY EYE SURGERY CENTER OF LOUISIANA | 621822003 - (LA) THE METAIRIE OPHTHALMOLOGY ASC, LLC DBA AMBULATORY EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7516 | $531.00 | 1528369972 - INSIGHT GROUP, LLC | 261871061 - (LA) INSIGHT GROUP LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7516 | $601.00 | 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 | 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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HCPCS C7516 vs. Other Miscellaneous Surgical Procedures Codes
The HCPCS C7516 code is part of the Outpatient PPS services used for Miscellaneous Surgical Procedures. 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 HCPCS C7516 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 |
|---|---|---|
| C7515-HCPCS | High | Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with dialysis circuit permanent endovascular embolization or occlusion of main circuit or any accessory veins, including all required imaging, radiological supervision and interpretation, image documentation and report |
| C7516-HCPCS | High | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report |
| C7517-HCPCS | Moderate | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C7516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C7516 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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