Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 20938 Fee Schedule
Last Verified: October 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 Struct Add-On, Autograft For Spine Surgery Only (Includes Harvesting The Graft); Structural Bicortical Or Tricortical (Through Separate Skin Or Fascial 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 80 - Assistant surgeon |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 20938 |
| Medicaid Fee Schedule | View Medicaid rates for 20938 |
National average reimbursement for CPT 20938 by major payers:
$225.25
$254.22
$271.84
$298.04
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 20938.
CPT 20938
5 of 25 sample ratesHigher to lower in this preview
Rock Hill Surgery Center, LLC, Carolina Surgical Center
Rock Hill Surgery Center LLC
$17,635.00Published rateSurgery Center Of Gilbert LLC, Surgery Center Of Gilbert
Surgery Center Of Gilbert, LLC
$3,157.00Published rateFoothill Surgery Center, LLC, Foothill Surgery Center
$2,328.00Published rateSurgicare Of Wichita, LLC
Surgicare Of Wichita LLC
$1,384.00Published rateSouthern Idaho Surgery Center PLLC
$940.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 20938 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20938 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 20938 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 |
| 20938-CPT | Moderate | Sp Bone Agrft Struct Add-On, Autograft For Spine Surgery Only (Includes Harvesting The Graft); Structural Bicortical Or Tricortical (Through Separate Skin Or Fascial 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 20938. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20938 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 20938) and we'll show you how you compare in 15 minutes or less.