CPT 20604 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 • RT - Right side of body • LT - Left side of body |
| Complexity Level | Low |
National average reimbursement for CPT 20604 by major payers:
$99.84
$101.53
$110.79
$139.10
| 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 20604 | ||||||
United | 20604 | $688.00 | 1518375641 - NORTH ANAHEIM SURGERY CENTER, LLC | 364790127 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20604 | $58.97 | 1144847104 - JNC PODIATRY LLC | 851603487 - (FL) JNC PODIATRY LLC | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 20604 | $94.00 | 1841270675 - EYECARE CONSULTANTS SURGERY CENTER, LLC, EYECARE CONSULTANTS SURGERY CENTER | 621619550 - (IN) EYECARE CONSULTANTS SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20604 | $137.00 | 1447685458 - CHECKERSPOT SURGERY CENTERS, LLC | 463181931 - (MD) CHECKERSPOT SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20604 | $572.00 | 1033635206 - MEDSTAR SURGERY CENTER AT TIMONIUM, LLC | 821874292 - (MD) MEDSTAR SURGERY CENTER AT TIMO | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20604 | $60.00 | 1326202086 - LAKEFOREST AMBULATORY SURGERY CENTER, DISTRICT HEIGHTS AMBULATORY SURGERY CENTER | 521944179 - (MD) LAKEFOREST AMBULATORY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20604 | $66.55 | 1023124609 - KEITH KALISH | 205462081 - (FL) KEITH J. KALISH, DPM, P.A. | FL | Foot Surgery Podiatrist (213ES0131X) |
United | 20604 | $375.00 | 1285608075 - PUEBLO CO OPHTHALMOLOGY ASC LLC, ROCKY MOUNTAIN LASER & SURGERY CENTER | 200121336 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20604 | $357.00 | 1740288679 - GULF COAST SURGICAL PARTNERS LLC | 631285913 - (AL) GULF COAST SURGICAL PARTNERS LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20604 | $60.59 | 1457616922 - ALEXANDER MOYA | 591664577 - PROJECT HEALTH INC | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 20604 | $66.55 | 1851783831 - WILLIAM BURMEISTER | 593605384 - (FL) FOOT AND ANKLE MANAGEMENT GROUP LLC | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 20604 | $566.00 | 1245605633 - HARBOR HEIGHTS SURGERY CENTER, LLC | 473886948 - (MD) HARBOR HEIGHTS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20604 | $156.55 | 1275952996 - STEPHEN BURKS | 592579938 - UNIVERSITY OF MIAMI | FL | Neurological Surgery Physician (207T00000X) |
United | 20604 | $151.58 | 1346225984 - JOHN ROBINSON | 205733575 | FL | Neurological Surgery Physician (207T00000X) |
United | 20604 | $602.00 | 1497465249 - CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION, CONFLUENCE HEALTH MOSES LAKE ASC | 910171250 - CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION | WA | 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 20604 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20604 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 20604 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 |
|---|---|---|
| 20550-CPT | Low | Inj Tendon Sheath Lig Trigger Pnt Gangli |
| 20600-CPT | Low | Arthrocentesis Aspiration And/Or Injection; Smalljoint Bursa(Eg Fingers Toes);Without Ultrasound Guidance (Desc Revised 1/1/15) |
| 20604-CPT | Low | Arthrocentesis, Aspiration And/Or Injection; Small Joint Or Bursa (Eg, Fingers, Toes) Including Ultrasound Guidance With Permanent Recording And Reporting |
| 20605-CPT | Low | Arthrocentesis Aspiration And/Or Injection; Intermediate Joint Bursa (Eg Temporomandibular Acromiomioclavicular Wrist Elbow Or Ankle Olecranon Bursa); Without Ultrasound Guidance (Desc Rev 1/1/15) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20604. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20604 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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