CPT 20610 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 |
| Medicare Fee Schedule | View Medicare rates for 20610 |
National average reimbursement for CPT 20610 by major payers:
$83.67
$87.35
$94.35
$107.22
| 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 20610 | ||||||
United | 20610 | $62.53 | 1902840119 - FARSHAD HANNANIAN | 133460911 - (NY) AMB MEDICAL SERVICES P.C. D/B/A DOC CARE | NY | Neurology Physician (2084N0400X) |
United | 20610 | $119.62 | 1770568990 - MAGDY EL-HENNAWY | 133956599 - BOSTON CHILDREN'S HEALTH PHYSICIANS, LLP | NY | Neonatal-Perinatal Medicine Physician (2080N0001X) |
United | 20610 | $42.95 | 1851371587 - GARY KELLER | 141941024 - (FL) ASSOCIATES LLC | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 20610 | $105.58 | 1689630352 - JEFFERY ANGEL | 710411459 | AR | Orthopaedic Surgery Physician (207X00000X) |
United | 20610 | $61.56 | 1356322986 - GEORGE IBARS | 261179038 - (FL) CONSULTANTS IN NEUROLOGICAL SURGERY, LLP | FL | Neurological Surgery Physician (207T00000X) |
United | 20610 | $301.83 | 1598922874 - JONATHAN GAMSS | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Internal Medicine Physician (207R00000X) |
United | 20610 | $151.76 | 1063874972 - MATTHEW REIFLER | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Family Medicine Physician (207Q00000X) |
United | 20610 | $301.83 | 1982185658 - NICOLE COTO | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Physician Assistant (363A00000X) |
United | 20610 | $53.07 | 1902840119 - FARSHAD HANNANIAN | 133460911 - (NY) AMB MEDICAL SERVICES P.C. D/B/A DOC CARE | NY | Neurology Physician (2084N0400X) |
United | 20610 | $151.76 | 1942456777 - ALEXANDER IRIBARNE | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NH | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician (208G00000X) |
United | 20610 | $126.41 | 1811383110 - BROCK KITCHEN | 205292952 | NV | Orthopaedic Surgery Physician (207X00000X) |
United | 20610 | $567.51 | 1194981506 - ANDRE MOREIRA | 135562308 - NEW YORK UNIVERSITY | NY | Colon & Rectal Surgery Physician (208C00000X) |
United | 20610 | $70.55 | 1447364534 - PATRICK GONZALEZ | 593362726 - (FL) PATRICK M GONZALEZ MD PA | FL | Physical Medicine & Rehabilitation Physician (208100000X) |
United | 20610 | $232.61 | 1508220542 - VIN SHEN BAN | 770465765 | CA | Neurological Surgery Physician (207T00000X) |
United | 20610 | $78.83 | 1760663363 - ARTHI REDDY | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Internal Medicine Physician (207R00000X) |
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 20610 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20610 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 20610 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 |
| 20553-CPT | Low | Injection(S); Tendon Sheath, Ligament; Single Or Multiple Trigger Point(S), Three Or More Muscles |
| 20600-CPT | Low | Arthrocentesis Aspiration And/Or Injection; Smalljoint Bursa(Eg Fingers Toes);Without Ultrasound Guidance (Desc Revised 1/1/15) |
| 20610-CPT | Low | Arthrocentesis Aspiration And/Or Injection; Majorjoint Or Bursa (Eg Shoulder Hip Knee Joint Su Bacromial Bursa); Without Ultrasound Guidance (Desc Revised 1/1/2015) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20610. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20610 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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