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See a sample rate comparisonCPT 20205 Fee Schedule
Medicare rates as of October 2026
CPT 20205 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Biopsy Muscle Deep
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22On Campus Outpatient Hospital 21Inpatient Hospital |
| Common Modifiers | LTLeft side of body RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5073 - Level 3 Excision/ Biopsy/ Incision and Drainage |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 03600361Sign up to view all 7 |
| Medicare Fee Schedule | $338.69 national non-facility rate (2026)View Medicare rates for 20205 |
| Medicaid Fee Schedule | $260.285 median of the 8 states in the free previewView Medicaid rates for 20205 |
National average reimbursement for CPT 20205 by major payers:
$364.49
BCBS / Anthem
$377.63
UnitedHealthcare
$418.47
Aetna
$258.74
Cigna
Compare published rates across providers.
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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 table lists codes related to 20205. Select one to see its fee schedule.
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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Frequently Asked Questions
What APC is CPT 20205 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 20205 to APC 5073 (Level 3 Excision/ Biopsy/ Incision and Drainage). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 20205 in an ambulatory surgery center?
CMS lists CPT 20205 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 20205?
Hospital price transparency files list CPT 20205 under these revenue codes: including 0360, 0361, 0761, 0975 and 0960. A revenue code names the hospital department or charge category for the line; it does not change what the service is.