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See a sample rate comparisonCPT 20931 Fee Schedule
Last Verified: September 2026
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.
Sp Bone Algrft Struct Add On, Allograft Structural For Spine Surgery Only List Separately In Addition To Code For Primary Procedure
| 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 AS - PA/NP/CNS assistant at surgery 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 20931 |
| Medicaid Fee Schedule | View Medicaid rates for 20931 |
National average reimbursement for CPT 20931 by major payers:
$151.02
$153.62
$162.74
$179.94
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CPT 20931
5 of 25 sample ratesHigher to lower in this preview
Los Gatos Surgical Center, A California Limited Partnership
$2,830.00Published rateTallahassee Orthpaedic Surgery Partners Ltd
$555.00Published rateBerks Center For Digestive Health, Lp
$235.00Published rateColonial Outpatient Surgery Center, LLC
Colonial Outpatient Surgery Center LLC
$115.00Published rateChildrens Surgery Center Of Malvern, LLC
Childrens Surgery Center Of Malvern LLC
$65.00Published rate
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See a sample payer proposalCPT 20931 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20931 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 20931 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 |
|---|---|---|
| 20930-CPT | Low | Sp Bone Algrft Morsel Add On, Allograft Morselized Or Placement Of Osteopromotive Material For Spine Surgery Only List Separately In Addition To Code For Primary Procedure |
| 20931-CPT | Low | Sp Bone Algrft Struct Add On, Allograft Structural For Spine Surgery Only List Separately In Addition To Code For Primary Procedure |
| 20932-CPT | Moderate | Osteoart Algrft W Surf B1, Allograft Includes Templating Cutting Placement And Internal Fixation When Performed Osteoarticular Including Articular Surface And Contiguous Bone List Separately In Addition To Code For Primary Procedure |
| 20936-CPT | Low | Sp Bone Agrft Local Add On, Autograft For Spine Surgery Only Includes Harvesting The Graft Local Eg Ribs Spinous Process Or Laminar Fragments Obtained From Same Incision 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 20931. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20931 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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