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See a sample rate comparisonCPT 20936 Fee Schedule
CPT 20936 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
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 | 21Inpatient Hospital 22On Campus Outpatient Hospital |
| Common Modifiers | ASPA/NP/CNS assistant at surgery GCService performed by resident under supervision |
| Surgery Center Payment (ASC) | N1 - Packaged; no separate payment |
| Add-on Code For | 2231922532Sign up to view all 23 |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | View Medicare rates for 20936 |
| Medicaid Fee Schedule | $123.98 median of the 8 states in the free previewView Medicaid rates for 20936 |
National average reimbursement for CPT 20936 by major payers:
$181.33
BCBS / Anthem
$171.35
UnitedHealthcare
$174.11
Aetna
$207.83
Cigna
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
$6,225.00Published rateMaple Lawn Surgery Center
Maple Lawn Surgery Center, LLC
$3,500.00Published rateNorthern New Jersey Center For Advanced Endoscopy LLC
$1,863.00Published rateCenter For Eye Surgery, LLC
Center For Eye Surgery LLC
$1,242.00Published rateFaysal Al-Ghoula
Deaconess Hospital Inc
$220.38Published rate
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See a sample payer proposalCPT 20936 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 20936. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 20930-CPT | 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 | Sp Bone Algrft Struct Add On, Allograft Structural For Spine Surgery Only List Separately In Addition To Code For Primary Procedure |
| 20932-CPT | 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 | 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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Frequently Asked Questions
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.
How does Medicare pay for CPT 20936 in an ambulatory surgery center?
CMS lists CPT 20936 with ASC payment indicator N1: Packaged; no separate payment.
Is CPT 20936 an add-on code?
Yes. CMS add-on code edits list CPT 20936 as an add-on code, billed with a primary code. Its primary codes: including 22319, 22532, 22533, 22548 and 22551.
Which revenue codes are billed with CPT 20936?
Hospital price transparency files list CPT 20936 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.