CPT 20694 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 20694 |
National average reimbursement for CPT 20694 by major payers:
$549.80
$573.59
$611.36
$714.14
| 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 20694 | ||||||
United | 20694 | $743.15 | 1871932442 - JONATHAN BALAGNA | 350593390 - DEACONESS HOSPITAL INC | IN | Interventional Cardiology Physician (207RI0011X) |
United | 20694 | $660.00 | 1184798837 - SHADELANDS ADVANCED ENDOSCOPY INSTITUTE, INC. | 205834466 - (CA) SHADELANDS ADVANCED ENDOSCOPY INSTITUTE INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $2216.00 | 1740236454 - PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT LLC, PRINCESS ANNE AMBULATORY SURGERY CENTER | 204920880 - (VA) PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $633.00 | 1396123865 - SOUND SURGEONS PLLC, NORTHWEST WEIGHT LOSS SURGERY | 461190829 - (WA) SOUND SURGEONS, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $925.00 | 1588046361 - NIAGARA ASC, LLC, ASC OF NIAGARA | 463471081 - (NY) NIAGARA ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $695.00 | 1093736795 - HATTIESBURG CLINIC PA, AMBULATORY SURGERY CENTER | 640507572 - HATTIESBURG CLINIC, P.A. | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $2382.00 | 1215134564 - EMMAUS SURGICAL CENTER, LLC | 208939316 - (NJ) EMMAUS SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $664.00 | 1942414750 - HAMILTON EYE INSTITUTE SURGERY CENTER, L.P. | 202873438 - (TN) HAMILTON EYE INSTITUTE SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $393.00 | 1811090350 - GREEN SURGERY CENTER LLC | 621770173 - (TN) GREEN SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $1258.00 | 1295860302 - GOLD COAST SURGERY CENTER LLC, GULF COMPREHENSIVE SURGERY CENTER | 203958739 - (FL) GOLD COAST SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $419.00 | 1750696134 - RMA OF PHILADELPHIA SURGICAL CENTER LLC | 273096545 - (PA) RMA OF PHILADELPHIA SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $771.00 | 1356773584 - SURGERY CENTER OF MUNSTER, LLC, THE CENTER FOR MINIMALLY INVASIVE SURGERY | 461961043 - (IN) SURGERY CENTER OF MUNSTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $4618.00 | 1609876556 - PEAK ONE SURGERY CENTER, LLC, PEAK ONE SURGERY CENTER | 201620230 - (CO) PEAK ONE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $2508.67 | 1205030731 - PIERCE STREET SAME DAY SURGERY, LC, PIERCE STREET SAME DAY SURGERY, LC | 205895205 - (IA) PIERCE STREET SAME DAY SURGERY | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20694 | $1528.00 | 1023191822 - SANTA BARBARA SURGERY CENTER LP | 371846158 | CA | 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 20694 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20694 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 20694 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 |
|---|---|---|
| 20650-CPT | Moderate | Insert Wire/Pin Skeletal Traction |
| 20692-CPT | High | Application Of A Multiplane (Pins Or Wires In More Than 1 Plane), Unilateral, External Fixation System (Eg, Ilizarov, Monticelli Type) |
| 20693-CPT | Moderate | Adjustment Or Revision Of External Fixation System Requiring Anesthesia (Eg, New Pin(S) Or Wire(S) And/Or New Ring(S) Or Bar(S)) |
| 20694-CPT | Moderate | Remove Under Anes Ext Fix Sys |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20694. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20694 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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