CPT 20969 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 62 - Co-Surgeons |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 20969 |
National average reimbursement for CPT 20969 by major payers:
$3,740.55
$3,751.24
$4,062.69
$4,604.49
| 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 20969 | ||||||
United | 20969 | $7121.00 | 1629510326 - COLLEGE PARK ENDOSCOPY CENTER, LLC, COLLEGE PARK SURGERY CENTER | 474427740 - (KS) COLLEGE PARK ENDOSCOPY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $2600.00 | 1679595680 - SURGERY CENTER OF LEBANON, LP, PHYSICIANS SURGICAL CENTER | 721588584 - (PA) SURGERY CENTER OF LEBANON LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $643.38 | 1841284742 - KLEINERT KUTZ SURGERY CENTER, LLC | 352095662 - (IN) KLEINERT KUTZ SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $1936.00 | 1871538694 - SOUTHWEST ENDOSCOPY LTD | 850452091 - (NM) SOUTHWEST ENDOSCOPY LTD | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $5354.00 | 1730369802 - SHORELINE SURGERY CENTER LLP, CHRISTUS SPOHN-SURGICARE OF CORPUS CHRISTI | 204911604 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $5775.00 | 1255797726 - BLOOMFIELD ASC LLC | 474758895 - (CT) BLOOMFIELD ASC, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $2509.00 | 1487609335 - THE CENTER FOR AESTHETIC SURGERY LLC | 200431536 - (MD) THE CENTER FOR AESTHETIC SURGERY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $774.00 | 1194999359 - JEFFREY L BOBER DPM PA, JEFFREY L BOBER DPM PA ASC | 521706931 - (MD) JEFFREY L BOBER DPM PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $1789.00 | 1881704237 - WATERFRONT SURGERY CENTER LLC | 251898743 - (PA) WATERFRONT SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $3365.00 | 1447347166 - UROLOGY SURGERY CENTER OF COLORADO LLC | 203146770 - (CO) UROLOGY SURGERY CENTER OF COLORADO LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $2209.00 | 1003871104 - MEMPHIS SURGERY CENTER LTD, LP, MEMPHIS SURGERY CENTER | 621218330 - (TN) MEMPHIS SURGERY CENTER, LTD, LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $5476.00 | 1447293113 - WESTERN AMBULATORY SURGERY LLC | 830303151 - (WY) WESTERN AMBULATORY SURGERY LLC | WY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $3600.00 | 1275546434 - MOUNTAIN VIEW ENDOSCOPY CENTER LP | 201417318 - (CA) MOUNTAIN VIEW ENDOSCOPY CENTER, | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $1850.00 | 1912412420 - GALEA CENTER, LLC., GALEA CENTER FOR ADVANCED SURGERY | 821939476 - (CA) GALEA CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20969 | $5433.00 | 1174778047 - RSC ILLINOIS LLC, REGIONAL SURGICENTER | 261363389 | IL | 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 20969 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20969 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 20969 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 |
|---|---|---|
| 20950-CPT | Moderate | Monitoring Of Interstitial Fluid Pressure (Includes Insertion Of Device, Eg, Wick Catheter Technique, Needle Manometer Technique) In Detection Of Muscle Compartment Syndrome |
| 20962-CPT | High | Graft Bone Microvasc Anastomosis |
| 20969-CPT | High | Free Osteo Flap W/Microvasc Other Area |
| 20970-CPT | High | Graft Ostecutaneous Iliac Crest |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20969. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20969 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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