What is CPT code 20936?

CPT code 20936 describes an autograft for spine surgery, specifically local harvesting from the same incision. It is used to document and receive reimbursement for visits involving moderate-level medical decision-making.

What factors affect fee schedules?

Fee schedules are affected by Medicare & Medicaid rates, private insurance negotiated rates, geographic location, and provider type. Costs may be higher in urban areas, and hospital providers may have different rates than private practice.

How can I view Medicare rates for CPT 20936?

You can view Medicare rates for CPT 20936 by visiting the PayerPrice Medicare fee schedule lookup page: https://payerprice.com/medicare-fee-schedule-lookup?codes=20936&year=2025,2026&medicareType=physician_ffs.

What is the complexity level of CPT 20936?

CPT 20936 is indicated to have a 'Low' complexity level based on the provided key facts, although the introductory text mentions it addresses 'moderate-level medical decision-making'.

How can I find the cost of a medical procedure or service?

The cost of medical procedures and services can vary significantly based on your insurance plan, geographic location, and the specific healthcare provider. For accurate, specific pricing information, you can utilize tools like Payerprice. Their fee schedule lookup tool allows you to search for costs using CPT codes and your specific location, which can provide a more precise estimate for your situation.

What is a CPT code and why is it important for understanding costs?

CPT stands for Current Procedural Terminology. CPT codes are a standardized set of five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services they provide. These codes are crucial for billing and for payers to determine reimbursement. Knowing the CPT code for a specific service helps you accurately search for pricing information, for example, using a tool like Payerprice.

Why is it often difficult to get an upfront estimate for healthcare costs?

Healthcare costs are often opaque due to several factors: the complex negotiation of rates between different insurance companies and providers, the varying impact of deductibles, co-pays, and co-insurance based on individual plans, and the potential for additional charges for ancillary services. These variables make it challenging to provide a simple, all-inclusive upfront cost.

Where can I find a fee schedule for healthcare services?

Fee schedules are complex and highly variable, differing by insurer, provider, and region. While general pricing data might be available from some sources, finding a precise fee schedule relevant to your specific needs can be challenging. For detailed fee schedule information that accounts for CPT codes and specific locations, Payerprice offers a specialized lookup tool designed to help you find relevant pricing data.

What resources are available to help me estimate my out-of-pocket medical expenses?

Several resources can assist with estimating medical expenses. Your health insurance company often provides tools, online portals, or customer service representatives who can help you understand your plan's coverage and potential out-of-pocket costs. Additionally, some hospitals offer price transparency tools for common procedures. For a more detailed and specific search using CPT codes and your exact location, Payerprice's fee schedule lookup tool is an excellent resource.

CPT 20936 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 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

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 GC - Service performed by resident under supervision
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 20936
Medicaid Fee Schedule	View Medicaid rates for 20936

National average reimbursement for CPT 20936 by major payers:

$181.33

$171.35

$174.11

$207.83

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 20936.

CPT 20936

5 of 25 sample ratesHigher to lower in this preview

The Emory Clinic Inc, Emory Ambulatory Surgery Center At Spivey Station
Emory University
GAAmbulatory Surgical Clinic/CenterNPI 1386165504Tax ID 58-2030692
$6,225.00Published rate
Maple Lawn Surgery Center
Maple Lawn Surgery Center, LLC
MDAmbulatory Surgical Clinic/CenterNPI 1255577045Tax ID 26-2739529
$3,500.00Published rate
Northern New Jersey Center For Advanced Endoscopy LLC
NJAmbulatory Surgical Clinic/CenterNPI 1346621893Tax ID 47-2128570
$1,863.00Published rate
Center For Eye Surgery, LLC
Center For Eye Surgery LLC
FLAmbulatory Surgical Clinic/CenterNPI 1134677990Tax ID 81-3369249
$1,242.00Published rate
Faysal Al-Ghoula
Deaconess Hospital Inc
MNPulmonary Disease PhysicianNPI 1477008670Tax ID 35-0593390
$220.38Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 20936 vs. Other Surgical Procedures on the Musculoskeletal System Codes

The CPT 20936 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 20936 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 20936. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 20936 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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CPT 20936 Fee Schedule

The Emory Clinic Inc, Emory Ambulatory Surgery Center At Spivey Station

Maple Lawn Surgery Center

Northern New Jersey Center For Advanced Endoscopy LLC

Center For Eye Surgery, LLC

Faysal Al-Ghoula