CPT 20922 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 • 51 - Multiple procedures • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 20922 |
National average reimbursement for CPT 20922 by major payers:
$776.83
$796.08
$847.18
$998.21
| 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 20922 | ||||||
United | 20922 | $891.00 | 1548582463 - CAREPLEX ORTHOPAEDIC AMBULATORY SURGERY CENTER, LLC, NONE | 271867311 - (VA) CAREPLEX ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $622.00 | 1588644520 - WESTGLEN ENDOSCOPY CENTER LLC, WESTGLEN ENDOSCOPY CENTER | 621707329 - WESTGLEN ENDOSCOPY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $2353.00 | 1295163715 - BLUFFTON OKATIE SURGERY CENTER, L.L.C. | 364730753 | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $1027.33 | 1942260138 - KARLA KITCH | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 20922 | $3993.00 | 1932104577 - CENTRAL AUSTIN AMBULATORY SURGERY CENTER L.P., DBA CENTRAL PARK SURGERY CENTER | 800776412 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $3430.00 | 1487136412 - ENDOSCOPY CENTER OF SOUTH SACRAMENTO, LLC, ENDOSCOPY CENTER OF SOUTH SACRAMENTO | 364904884 - (CA) ENDOSCOPY CENTER OF SOUTH SACRAMENTO LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $926.00 | 1679658710 - STADIUM CAMPUS AMBULATORY SURGICAL CENTER, LLC, WILLS EYE SURGERY CENTER | 232981922 - (PA) STADIUM CAMPUS AMBULATORY SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $897.00 | 1073079596 - PREMIER GASTROENTEROLOGY ASSOCIATES PLLC, PREMIER SURGERY CENTER | 824134212 - (AR) PREMIER GASTROENTEROLOGY ASSOCIATES, PLLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $936.00 | 1205853041 - EUCLID ENDOSCOPY CENTER, LP | 203197449 - (CA) EUCLID ENDOSCOPY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $1200.00 | 1306079330 - WHITEWATER SURGERY CENTER LLC, WHITEWATER SURGERY CENTER | 264540954 - (IN) WHITEWATER SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $2206.00 | 1114126596 - CORAL RIDGE OUTPATIENT CENTER LLC, CORAL RIDGE OUTPATIENT CENTER | 205429299 - (FL) CORAL RIDGE OUTPATIENT CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $954.00 | 1417903899 - JUPITER OUTPATIENT SURGERY CENTER LLC | 650925020 - (FL) JUPITER OUTPATIENT SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $848.00 | 1316969058 - BETHESDA ENDOSCOPY CENTER, LLC | 521915901 - (MD) BETHESDA ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $1968.00 | 1013539709 - BSC BILTMORE LLC | 850820003 - (AZ) BSC BILTMORE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20922 | $958.00 | 1780658245 - ROGERS AR OPHTHALMOLOGY ASC LLC, BOOZMAN-HOF EYE SURGERY & LASER CENTER | 753069680 - (AR) ROGERS AR OPHTHALMOLOGY ASC LLC | AR | 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 20922 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20922 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 20922 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 |
|---|---|---|
| 20920-CPT | Moderate | Fascia Lata Graft By Stripper |
| 20922-CPT | Moderate | Graft Fascia Lata Incis/Area Expos |
| 20924-CPT | Moderate | Tendon Graft From Distance |
| 20930-CPT | Low | Allograft, Morselized, Or Placement Of Osteopromotive Material, For Spine Surgery Only; (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20922. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20922 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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