CPT 20931 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 • AS - PA/NP/CNS assistant at surgery • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 20931 |
National average reimbursement for CPT 20931 by major payers:
$151.02
$153.62
$162.74
$183.53
| 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 20931 | ||||||
United | 20931 | $187.91 | 1548379738 - TEODORA BOTEZ | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 20931 | $240.00 | 1346213634 - SARASOTA ENDOSCOPY ASC LLC, BAYVIEW ENDOSCOPY CENTER | 621806248 - (FL) THE SARASOTA ENDOSCOPY ASC, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $477.00 | 1043690845 - UNION HILLS PAIN PARTNERS LLC, HONORHEALTH PAIN MANAGEMENT CENTER | 473325492 - (AZ) UNION HILLS PAIN PARTNERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $235.00 | 1639176183 - BERKS CENTER FOR DIGESTIVE HEALTH, LP | 233068912 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $1413.00 | 1497749436 - NEW JERSEY SURGERY CENTER LLC, NEW JERSEY SURGERY CENTER | 161666417 - (NJ) NEW JERSEY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $97.00 | 1831109875 - M-S SURGERY CENTER LLC | 205219388 - (CA) MS SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $906.00 | 1447347166 - UROLOGY SURGERY CENTER OF COLORADO LLC | 203146770 - (CO) UROLOGY SURGERY CENTER OF COLORADO LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $963.00 | 1366137440 - SURGERY CENTER OF GEORGETOWN, LLC, GEORGETOWN SURGERY CENTER | 880604963 - (TX) SURGERY CENTER OF GEORGETOWN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $86.33 | 1447922547 - ANNA BOONE | 350593390 - DEACONESS HOSPITAL INC | KY | Pediatric Nurse Practitioner (363LP0200X) |
United | 20931 | $574.00 | 1154956928 - ADVANCED SURGICAL CARE OF CLEARWATER LLC | 833698204 - (FL) ADVANCED SURGICAL CARE OF CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $2830.00 | 1801859970 - LOS GATOS SURGICAL CENTER, A CALIFORNIA LIMITED PARTNERSHIP | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $65.00 | 1134499684 - CHILDRENS SURGERY CENTER OF MALVERN, LLC | 452608984 - (PA) CHILDRENS SURGERY CENTER OF MALVERN LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $574.00 | 1548784556 - NORTH ATLANTIC SURGICAL SUITES, LLC | 821540859 - (NH) NORTH ATLANTIC SURGICAL SUITES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $115.00 | 1639650161 - TRAILS EDGE SURGERY CENTER, LLC | 831528858 - (FL) TRAILS EDGE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20931 | $70.00 | 1447234919 - GENGASTRO LLC, ENDOSCOPY CENTER FOR DIGESTIVE HEALTH | 562315623 - (IA) GENGASTRO LLC | IA | 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 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 | Allograft, Morselized, Or Placement Of Osteopromotive Material, For Spine Surgery Only; (List Separately In Addition To Code For Primary Procedure) |
| 20931-CPT | Low | Allograft, Structural, For Spine Surgery Only; (List Separately In Addition To Code For Primary Procedure) |
| 20932-CPT | Moderate | 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 Pro- Cedure |
| 20936-CPT | Low | 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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