CPT 20985 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • RT - Right side of body |
| Complexity Level | Low |
National average reimbursement for CPT 20985 by major payers:
$180.29
$198.95
$206.50
$251.01
| 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 20985 | ||||||
United | 20985 | $531.00 | 1326435926 - SELECT PHYSICIANS SURGERY CENTERS | 383935220 - (FL) SELECT PHYSICIANS SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $60.00 | 1467844068 - WEST ANNAPOLIS SURGERY CENTER, LLC | 472474153 - (MD) WEST ANNAPOLIS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $566.00 | 1669574539 - MANCHESTER SURGERY CENTER, LLC | 205953313 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $788.00 | 1215283866 - EC LASER AND SURGERY INSTITUTE OF WI, LLC | 454182045 - (WI) EC LASER AND SURGERY INSTITUTE OF WI LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $39.00 | 1295494359 - ATLANTIC SC LLC | 832941937 - (NY) ATLANTIC SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $163.00 | 1609977610 - UOC SURGICAL SERVICES, LTD. | 251890694 - (PA) UOC SURGICAL SERVICES LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $633.00 | 1740673953 - MANCHESTER AMBULATORY SURGERY CENTER LP, DES PERES SQUARE SURGERY CENTER | 205953313 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $163.00 | 1003887225 - CENTRAL TEXAS ENDOSCOPY CENTER LLC, CENTRAL TEXAS ENDOSCOPY CENTER | 742863853 - (TX) CENTRAL TEXAS ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $356.00 | 1881089076 - FREEMAN SURGICAL CENTER OF PITTSBURG, LLC | 473537670 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $574.00 | 1841316841 - PACIFIC ENDOSCOPY CENTER, LLC | 203905706 - (HI) PACIFIC ENDOSCOPY CENTER, LLC | HI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $601.00 | 1942230024 - LUTHERVILLE ENDOSCOPY CENTER LLC | 823193901 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $76.00 | 1992701049 - NORTHWEST FLORIDA SURGERY CENTER | 593123289 - (FL) NORTHWEST FLORIDA SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $320.00 | 1205839487 - INTERVENTIONAL REHABILITATION CENTER, LLC | 593673361 - (FL) INTERVENTIONAL REHABILITATION CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $134.00 | 1740785096 - GASTROINTESTINAL ENDOSCOPY CENTER LLC | 822081770 - (PA) GASTROINTESTINAL ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 20985 | $150.00 | 1619935483 - OUTPATIENT SURGERY CENTER OF HILTON HEAD | 611409045 - (SC) OUTPATIENT SURGERY CENTER OF HILTON HEAD | SC | 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 20985 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20985 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 20985 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 |
| 20973-CPT | High | Free Osteo Flap W/Microvasc Great Toe W/ |
| 20974-CPT | Low | Stimulate Bone Electric Noninvasive |
| 20985-CPT | Low | Computer-Assisted Surgical Navigational Procedure For Musculoskeletal Procedures Image-Less (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 20985. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20985 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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