CPT 20974 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 | • 11 - Office • 24 - Ambulatory Surgical Center • 21 - Inpatient Hospital |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • LT - Left side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 20974 |
National average reimbursement for CPT 20974 by major payers:
$100.29
$99.70
$108.67
$133.09
| 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 20974 | ||||||
United | 20974 | $125.00 | 1891728382 - MISSISSIPPI COAST ENDOSCOPY & AMBULATORY CENTER LLC, MISSISSIPPI COAST ENDOSCOPY & AMBULATORY SURGICAL | 640927074 - (MS) MISSISSIPPI COAST ENDOSCOPY AND AMBULATORY CENTER, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $211.00 | 1366684326 - PRINCE FREDERICK SURGERY CENTER LLC | 264387021 - (MD) PRINCE FREDERICK SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $93.00 | 1508839473 - NEWARK ENDOSCOPY ASC LLC, ENDOSCOPY CENTER OF DELAWARE | 621867825 - (DE) NEWARK ENDOSCOPY ASC LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $910.00 | 1700057254 - NORTH STATE SURGERY CENTERS, LP, MERCY SURGERY CENTER | 300197423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $634.00 | 1215990627 - WESTSIDE SURGERY CENTER LLC, WESTSIDE SURGERY CENTER LTD | 593026856 - (FL) WESTSIDE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $1369.00 | 1841858024 - VANGUARD ASC, LLC, VANGUARD SURGICAL CENTER | 352661529 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $101.00 | 1619998523 - UPSTATE SURGERY CENTER, LLC | 562186977 - (SC) UPSTATE SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $521.00 | 1154460525 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON LYNNWOOD ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $115.00 | 1053632372 - ORTHOATLANTA SURGERY CENTER OF AUSTELL, LLC | 272363967 - (GA) ORTHOATLANTA SURGERY CENTER OF AUSTELL LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $574.00 | 1649707324 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $69.00 | 1588802987 - NATIONAL PARK ENDOSCOPY CENTER, LLC, SOUTH CENTRAL ENDOSCOPY | 900881332 - (AR) NATIONAL PARK ENDOSCOPY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $92.00 | 1821279720 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND THERAPEUTIC CENTER | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $555.00 | 1366935074 - SKYWAY SURGERY CENTER, LLC | 813237016 - (FL) SKYWAY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $500.00 | 1174670723 - GASTROINTESTINAL INSTITUTE, LLC. | 201622626 - (IL) GASTROINTESTINAL INSTITUTE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20974 | $301.00 | 1588302707 - ALLINA HEALTH SURGERY CENTER- VADNAIS HEIGHTS LLC | 882406421 - (MN) ALLINA HEALTH SURGERY CENTER VADNAIS HEIGHTS LLC | MN | 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 20974 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20974 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 20974 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 |
| 20973-CPT | High | Free Osteo Flap W/Microvasc Great Toe W/ |
| 20974-CPT | Low | Stimulate Bone Electric Noninvasive |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20974. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20974 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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