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See a sample rate comparisonCPT 20816 Fee Schedule
Last Verified: October 2026
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.
Replantation Digit Complete, Replantation Digit Excluding Thumb Includes Metacarpophalangeal Joint To Insertion Of Flexor Sublimis Tendon Complete Amputation
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 20816 |
National average reimbursement for CPT 20816 by major payers:
$2,976.03
$2,933.81
$2,896.61
$3,450.06
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CPT 20816
5 of 25 sample ratesHigher to lower in this preview
Ascension Wisconsin Surgery Center-Mount Pleasant LLC, Ascension Wisconsin Surgery Center-Mount Pleasant
Ascension Wisconsin Surgery Centermount Pleasant LLC
$9,464.00Published rateSurgery Center Of Georgetown, LLC, Georgetown Surgery Center
Surgery Center Of Georgetown LLC
$3,943.00Published rateIndiana Vascular Surgery Center LLC
$3,217.00Published rateRaleigh Nc Endoscopy Asc LLC, Raleigh Endoscopy Center
Raleigh Nc Endoscopy Asc LLC
$2,686.00Published rateAssociated Urologists Ambulatory Surgery Center LLC
$878.00Published rate
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See a sample payer proposalCPT 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 Complete, Replantation Digit Excluding Thumb Includes Metacarpophalangeal Joint To Insertion Of Flexor Sublimis Tendon Complete Amputation |
| 20822-CPT | High | Replantation Digit Complete, Replantation Digit Excluding Thumb Includes Distal Tip To Sublimis Tendon Insertion Complete Amputation |
| 20824-CPT | High | Replant Thumb (Inclu Carpometacarp Joint To Mp Joint) Comp, Replantation Thumb (Includes Carpometacarpal Joint To Mp Joint) Comp |
| 20924-CPT | Moderate | Tndon Grft From A Distanc (Eg Palmaris Toe Extenso Plantari), Tendon Graft From A Distance (Eg Palmaris Toe Extensor Plantaris) |
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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