How much does Medicare pay for CPT 64561?

Medicare allowed an average of $2661.59 per service and paid $2117.56 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $9627.69, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 64561?

Insertion of sacral nerve neurostimulator electrode array. It was billed 24,882 times to 15,845 Medicare beneficiaries by 624 providers in 2024.

Does 64561 pay differently in an office than a hospital?

Yes. The allowed amount averaged $980.25 in an office setting and $2806.87 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 64561 most?

Ambulatory Surgical Center, with 12,874 services from 204 clinicians. Next are Urology, Obstetrics & Gynecology, Anesthesiology.

CPT 64561

Insertion of sacral nerve neurostimulator electrode array

$2661.59Medicare-allowed amount per service, averaged across 24,882 services

Providers submitted

$9627.69

Asking price, not received

Medicare allowed

$2661.59

The fee schedule figure

Medicare paid

$2117.56

Balance is patient coinsurance

Providers submitted an average of $9627.69 for this code and Medicare allowed $2661.59 — 3.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $2117.56 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $980.25
Hospital / facility: $2806.87

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,979 services were billed in an office setting and 22,903 in a facility.

Services: 24,882
Beneficiaries: 15,845
Providers billing it: 624
Total allowed: $66,225,682

What Medicare pays for CPT 64561

Across 24,882 services billed by 624 providers to 15,845 beneficiaries, Medicare allowed an average of $2661.59 per service. That is 1.6 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 64561

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	12,874	6,251	$4719.05	204
Urology	8,046	6,373	$458.17	297
Obstetrics & Gynecology	3,080	2,484	$441.97	91
Anesthesiology	211	125	$289.89	1
Gastroenterology	181	181	$445.30	8
Colorectal Surgery (Proctology)	110	77	$325.88	5
Physician Assistant	102	102	$851.16	6
Nurse Practitioner	94	94	$739.52	6
General Surgery	93	67	$354.66	4
Undefined Physician type	91	91	$636.53	2

64561 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	3,984	$2696.66	$2300.07	91
Arkansas	2,229	$2573.40	$2335.90	21
Arizona	1,611	$3113.77	$2520.52	32
Texas	1,590	$2716.45	$2263.79	46
Georgia	1,517	$3003.51	$2411.97	37
Mississippi	1,492	$2635.61	$2356.50	20
Maryland	1,125	$3219.29	$2634.38	28
Tennessee	922	$2038.42	$1772.27	30
Colorado	741	$3008.10	$2418.80	21
California	712	$3065.30	$2065.13	30
Pennsylvania	700	$3000.37	$2412.54	22
New York	630	$2688.84	$1991.72	14
Nebraska	596	$3115.50	$2576.95	14
South Carolina	579	$2204.84	$1889.26	17
Kentucky	568	$4290.86	$3641.51	6
Ohio	470	$1646.05	$1396.73	19
Kansas	461	$2775.38	$2428.08	12
Oklahoma	460	$2541.94	$2207.15	14
Missouri	430	$2408.56	$1996.02	12
Indiana	428	$536.01	$441.77	10
Massachusetts	386	$1960.44	$1399.66	11
Virginia	384	$2411.90	$1991.33	14
Michigan	354	$2485.63	$2073.96	11
Alabama	337	$2191.49	$2038.98	8
Washington	310	$2869.27	$2116.82	13
New Jersey	268	$2747.07	$2072.55	9
Minnesota	228	$2977.00	$2343.52	7
North Carolina	204	$1329.07	$1150.62	10
Louisiana	202	$2647.26	$2424.62	7
South Dakota	182	$1890.92	$1671.76	4
Iowa	177	$2923.48	$2624.23	7
Nevada	171	$2076.13	$1764.90	4
Illinois	124	$1885.42	$1486.48	7
North Dakota	60	$337.82	$275.20	2
Montana	42	$358.31	$290.41	3
New Hampshire	36	$372.27	$286.86	1
Maine	35	$341.59	$274.20	2
Wisconsin	35	$2169.72	$1741.33	2
Oregon	28	$359.13	$288.73	2
Delaware	24	$363.45	$281.67	1
Idaho	23	$4729.23	$3949.07	1
New Mexico	14	$1076.56	$842.91	1
Connecticut	13	$1205.04	$812.38	1

Related codes

64566Insertion of lower leg neurostimulator electrode$111.18
64590Insertion or replacement of peripheral$7256.19
64555Insertion of peripheral nerve neurostimulator electrode through skin$2824.92
64582Insertion of hypoglossal nerve neurostimulator electrode and generator$1710.79
64520Injection of anesthetic agent into middle or lower spine sympathetic n$263.66
64510Injection of anesthetic agent into sympathetic nerve bundle$184.69

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.