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See a sample rate comparisonCPT 20205 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Biopsy Muscle Deep
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 20205 |
| Medicaid Fee Schedule | View Medicaid rates for 20205 |
National average reimbursement for CPT 20205 by major payers:
$364.49
$377.63
$418.47
$258.74
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CPT 20205
5 of 25 sample ratesHigher to lower in this preview
Surgical Center At Millburn, LLC
Surgical Center At Millburn LLC
$2,122.00Published rateSurgery Center At St. Vincent, LLC, East Pavilion Surgery Center
Surgery Center At St Vincent LLC
$1,072.50Published rateInterventional Spine Center, LLC
Interventional Spine Center LLC
$764.00Published rateOptumcare Colorado Asc, LLC
$577.00Published rateBaltimore Endoscopy Asc LLC, Gastrointestinal Diagnostic Center
Baltimore Endoscopy Asc LLC
$398.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 20205 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20205 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal 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 20205 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 |
|---|---|---|
| 20200-CPT | Moderate | Biopsy Muscle Superficial |
| 20205-CPT | Moderate | Biopsy Muscle Deep |
| 20206-CPT | Moderate | Biopsy Muscle Percutaneous Needle |
| 20501-CPT | Low | Dye Injection To View Sinuses, An Injection Of Contrast Material Into A Sinus In Order To Identify The Location Of An Infection Or Fluid-Filled Area. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20205 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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