CPT 20555 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 20555 |
National average reimbursement for CPT 20555 by major payers:
$454.05
$442.50
$448.52
$568.31
| 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 CPT 20555 | ||||||
United | 20555 | $2388.00 | 1649707324 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $1479.00 | 1497834931 - VISION CARE CENTER, A MEDICAL GROUP INC, EYE-Q SURGERY CENTER | 941717441 - VISION CARE CENTER, A MEDICAL GROUP, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $614.00 | 1326563537 - OPTUMCARE COLORADO ASC, LLC | 352597463 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $2430.00 | 1033635206 - MEDSTAR SURGERY CENTER AT TIMONIUM, LLC | 821874292 - (MD) MEDSTAR SURGERY CENTER AT TIMO | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $2750.00 | 1508276080 - OHIO SPECIALTY SURGICAL SUITES, LLC | 464078247 - (OH) OHIO SPECIALTY SURGICAL SUITES LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $2844.00 | 1164019485 - WAUKESHA SURGICENTER, LLC | 854083608 - (WI) WAUKESHA SURGICENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $1750.00 | 1154959179 - MUNSTER SURGERY CENTER LLC | 844828519 - (IN) MUNSTER SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $2007.00 | 1013539709 - BSC BILTMORE LLC | 850820003 - (AZ) BSC BILTMORE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $981.00 | 1215931134 - CUMBERLAND VALLEY SURGICAL CENTER, LLC | 611348280 - (KY) CUMBERLAND VALLEY SURGICAL CENTER LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $1678.00 | 1124093588 - UROLOGY SURGERY CENTER OF SAVANNAH, LLLP, UROLOGY SURGERY CENTER, LLP | 582511751 - (GA) UROLOGY SURGERY CENTER OF SAVANNAH LLLP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $1213.00 | 1104877976 - VICTOR R. MICHALAK, DBA COSMETIC SURGERY & DERMATOLOGY OF ISSAQUAH, INC. | 911521306 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $731.00 | 1396897260 - LITTLE ROCK FERTILITY CENTER | 861078562 - (AR) LITTLE ROCK FERTILITY CENTER | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $2353.00 | 1992713176 - DESERT RIDGE OUTPATIENT SURGERY LLC | 202528902 - (AZ) DESERT RIDGE OUTPATIENT SURGERY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $1955.00 | 1952698078 - EXECUTIVE SURGERY CENTER, INC. | 452484347 - (CA) EXECUTIVE SURGERY CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20555 | $995.00 | 1053301473 - BAKER AMBULATORY SURGERY CENTER | 710839283 - (AR) BAKER AMBULATORY SURGERY CENTER | AR | 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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CPT 20555 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20555 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 20555 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 |
|---|---|---|
| 20220-CPT | Moderate | Bone Biopsy Trocar/Needle Superficial |
| 20245-CPT | Moderate | Biopsy Bone Open; Deep (Eg Humeral Shaft Ischium Femoral Shaft). (Desc Revised 1/1/2017) |
| 20555-CPT | Moderate | Placement Of Needles Or Catheters Into Muscle And/Or Soft Tissue For Subsequent Interstitial Radioelement Application (At The Time Of Or Subsequent To The Procedure) |
| 20692-CPT | High | Application Of A Multiplane (Pins Or Wires In More Than 1 Plane), Unilateral, External Fixation System (Eg, Ilizarov, Monticelli Type) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20555. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20555 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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