What is the standard insurance baseline for CPT 96522?

The standard insurance baseline reimbursement rate is $122.89. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Refilling and Maintenance of Implantable Pump or Reservoir for Drug Delivery

CPT 96522Medical Service

Refilling and Maintenance of Implantable Pump or Reservoir for Drug Delivery

Q: What do doctors typically charge for Refilling and Maintenance of Implantable Pump or Reservoir for Drug Delivery?

The nationwide median physician charge for Refilling and Maintenance of Implantable Pump or Reservoir for Drug Delivery (CPT 96522) is $268.00. Doctor billed charges vary based on geographic region, setting, and overhead.

Refilling and maintenance of implantable pump or reservoir for drug delivery. Clinical pricing breakdown and utilization metrics across 8 practicing doctors nationwide.

$268.00

Peer Median Charge

Gross billed rate

$122.89

Standard Baseline

Customary allowable

2.2x

National Markup

Charge vs baseline

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $268.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $122.89 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 96522 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"