CPT 20936 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 • GC - Service performed by resident under supervision |
| Complexity Level | Low |
National average reimbursement for CPT 20936 by major payers:
$181.33
$171.35
$174.11
$211.64
| 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 20936 | ||||||
United | 20936 | $1878.00 | 1639499627 - GEORGIA UROLOGY, PA, GEORGIA UROLOGY ASC MARIETTA | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $3613.00 | 1225091739 - OUTPATIENT WOMEN'S AND CHILDREN'S SURGERY CENTER, LTD | 432016059 - (TX) OUTPATIENT WOMENS AND CHILDRENS SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $685.00 | 1023039195 - CAPE SURGERY CENTER, LLC | 200649544 - (TN) CAPE SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $3570.00 | 1962671487 - HYDE PARK SURGERY CENTER, LLC, HYDE PARK SURGERY CENTER, LP | 421731685 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $1244.00 | 1477562148 - SANI EYE CENTER, INC., SANI EYE SURGERY CENTER | 953764955 - (CA) SANI EYE CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $4600.00 | 1487371431 - BAYLOR SCOTT & WHITE SURGICARE WAXAHACHIE LLC | 920758698 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $643.00 | 1215919113 - VISION INSTITUTE OF MICHIGAN SURGERY CENTER PC, SURGERY CENTER OF MICHIGAN | 382945641 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $2610.00 | 1225452303 - MARTHA JEFFERSON HOSPITAL, MARTHA JEFFERSON OUTPATIENT SURGERY CENTER | 540261840 - (VA) MARTHA JEFFERSON HOSPITAL | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $2100.00 | 1043760184 - AUBURN SURGERY CENTER INC | 431937843 - (MO) AUBURN SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $4074.00 | 1821429978 - EL MIRADOR SURGERY CENTER LLC, EL MIRADOR SURGERY CENTER | 300798280 - (CA) EL MIRADOR SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $844.00 | 1619920501 - CENTER FOR DIGESTIVE HEALTH | 364532301 - (IL) THE CENTER FOR DIGESTIVE HEALTH, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $1253.00 | 1932274743 - COASTAL CAROLINA CENTERS OF UROLOGY AND SURGERY LLC, RIVERTOWN SURGERY CENTER | 593700931 - (SC) COASTAL CAROLINA CENTERS OF UROLOGY AND SURGERY LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $3500.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $3495.00 | 1306833009 - SOUTH BROWARD ENDOSCOPY L L C | 113685842 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20936 | $2855.00 | 1780109934 - BANNER MESA SURGERY CENTER LLC | 901182682 - (AZ) BANNER MESA SURGERY CENTER LLC | AZ | 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 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 | 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 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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