CPT 20816 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • F1 - Left hand, second digit • F8 - Right hand, fourth digit |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 20816 |
National average reimbursement for CPT 20816 by major payers:
$2,976.03
$2,933.81
$2,896.61
$3,532.47
| 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 20816 | ||||||
United | 20816 | $2922.00 | 1073620415 - NORTH BAY EYE ASSOCIATES A MEDICAL CORPORATION, NORTH BAY EYE ASSOCIATES ASC | 680368973 - (CA) NORTH BAY EYE ASSOCIATES | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $1127.00 | 1730614330 - GYPSY LANE ENDOSCOPY SUITES, INC. | 475672535 - (OH) GYPSY LANE ENDOSCOPY SUITES INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $2173.00 | 1750414983 - ROCKLEDGE SURGERY CENTER, INC. | 522098503 - (MD) ROCKLEDGE SURGERY CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $3515.00 | 1699054098 - SURGCENTER OF WESTERN MARYLAND, LLC | 272969860 - (MD) SURGCENTER OF WESTERN MARYLAND, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $5846.00 | 1881339133 - BSC SHEA PARK LLC | 881850069 - (AZ) BSC SHEA PARK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $3070.00 | 1518450790 - VIRGINIA ENT SURGERY CENTER INC | 541052755 - (VA) VIRGINIA EAR, NOSE & THROAT ASSOCIATES, P.C. | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $1131.00 | 1609930676 - BAYWOOD MEDICAL ASSOCIATES, PLLC, DESERT PAIN INSTITUTE - ASC | 861006533 - (AZ) BAYWOOD MEDICAL ASSOCIATES, PLLC DBA DESERT PAIN INSTITUTE | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $3217.00 | 1053058255 - INDIANA VASCULAR SURGERY CENTER LLC | 871608290 - (IN) INDIANA VASCULAR SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $3275.00 | 1124587548 - GATEWAY SURGICAL CENTER, LLC | 830521568 - (TX) GATEWAY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $5574.00 | 1245233220 - NORTHRIDGE SURGERY CENTER, LP, NORTHRIDGE SURGERY CENTER | 690003768 - (TN) NORTHRIDGE SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $9464.00 | 1013548833 - ASCENSION WISCONSIN SURGERY CENTER-MOUNT PLEASANT LLC, ASCENSION WISCONSIN SURGERY CENTER-MOUNT PLEASANT | 843972619 - (WI) ASCENSION WISCONSIN SURGERY CENTERMOUNT PLEASANT LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $2890.00 | 1972141455 - FALLSGROVE ENDOSCOPY CENTER, LLC | 842186338 - (MD) FALLSGROVE ENDOSCOPY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $2884.00 | 1720129893 - PACIFIC GASTROENTEROLOGY ENDOSCOPY CENTER | 330898866 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $3780.00 | 1164656740 - SURGERY CENTER OF MOUNT DORA, LLC | 262446297 - (FL) SURGERY CENTER OF MOUNT DORA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20816 | $3500.00 | 1891770814 - REGIONAL HAND CENTER OF CENTRAL CALIFORNIA, INC | 770521088 | 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 20816 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20816 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 20816 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 |
|---|---|---|
| 20816-CPT | High | Replantation, Digit, Excluding Thumb (Includes Metacarpophalangeal Joint To Insertion Of Flexor Sublimis Tendon), Complete Amputation |
| 20822-CPT | High | Replant Digit Tip To Flex Sublimis Compl |
| 20824-CPT | High | Replant Thumb Carpo To Mp Complete Amp |
| 20924-CPT | Moderate | Tendon Graft From Distance |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20816. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20816 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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