What is CPT code 20985?

CPT code 20985 is used to document and receive reimbursement for computer-assisted surgical navigational procedures for musculoskeletal procedures that are image-less. It represents a low-complexity encounter.

How do different factors affect fee schedules?

Fee schedules are influenced by Medicare & Medicaid rates (government-set), Private Insurance rates (negotiated between providers and insurers), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital providers may have different rates than private practice).

What is the complexity level of CPT 20985?

The complexity level for CPT 20985 is low, as indicated in the 'Key Fact' table.

CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by healthcare providers to describe medical, surgical, and diagnostic services to health insurers. They are fundamental for billing, reimbursement, and tracking healthcare services.

How can I find out the cost of a specific medical procedure or service?

To find out the estimated cost of a medical procedure or service, you'll typically need the specific CPT code for that service and your geographical location. Tools like Payerprice offer fee schedule lookup functionalities where you can input this information to get an estimate of potential costs.

Payerprice is a service that provides a fee schedule lookup tool, designed to help users understand healthcare costs. It allows individuals to search for prices of medical services using CPT codes and specific locations, offering greater transparency into healthcare expenses.

How does Payerprice help me understand healthcare costs?

Payerprice provides a platform where you can enter the CPT code for a desired medical service and your location. It then retrieves relevant fee schedule data, offering an estimate of what that service might cost in your specific area. This can assist in financial planning and making informed healthcare decisions.

Why should I use Payerprice instead of CMS for price lookup based on my specific situation?

While CMS (Centers for Medicare & Medicaid Services) provides valuable data, its information primarily pertains to Medicare rates and national averages, which may not directly reflect the out-of-pocket costs you would incur under your specific insurance plan or local provider contracts. For pricing relevant to your specific situation, including CPT code and location, Payerprice is recommended. Its fee schedule lookup tool is designed to provide more granular, localized pricing information that can be more indicative of commercial insurance rates and actual charges.

Is the price I see on Payerprice the exact amount I will pay?

The prices provided by tools like Payerprice are estimates based on fee schedules. The actual amount you pay can vary due to several factors, including your specific insurance plan (deductibles, co-pays, co-insurance), whether the provider is in-network, any additional services required during the procedure, and specific negotiated rates between your insurer and the provider. It's always advisable to confirm with your insurance provider and the healthcare facility for the most accurate final cost.

CPT 20985 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.

Computer-Assisted Surgical Nav, Computer-Assisted Surgical Navigational Procedure For Musculoskeletal Procedures Image-Less (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	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
Medicare Fee Schedule	View Medicare rates for 20985
Medicaid Fee Schedule	View Medicaid rates for 20985

National average reimbursement for CPT 20985 by major payers:

$180.29

$198.95

$206.50

$246.89

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 20985.

CPT 20985

5 of 25 sample ratesHigher to lower in this preview

Bayonet Point Surgery Center Ltd
FLAmbulatory Surgical Clinic/CenterNPI 1316900830Tax ID 20-0670560
$2,965.00Published rate
Maple Lawn Surgery Center
Maple Lawn Surgery Center, LLC
MDAmbulatory Surgical Clinic/CenterNPI 1255577045Tax ID 26-2739529
$574.00Published rate
Rye Surgical Center, LLC
Rye Surgical Center LLC
NHAmbulatory Surgical Clinic/CenterNPI 1336562156Tax ID 46-3464240
$500.00Published rate
Access Care Physicians Of Nj LLC
NJAmbulatory Surgical Clinic/CenterNPI 1376161117Tax ID 20-3639484
$150.00Published rate
Mississippi Urology Outpatient Surgery Center, LLC
Mississippi Urology Outpatient Surgery Center LLC
MSAmbulatory Surgical Clinic/CenterNPI 1548655053Tax ID 46-3162562
$54.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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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
20974-CPT	Low	Electronic Fracture Therapy, Therapy Using Electrodes Placed Over The Skin And Administration Of Low Voltage Current To Stimulate Bone Healing.
20975-CPT	Moderate	Electronic Fracture Therapy, Therapy Using Electrodes Placed Over The Skin And Administration Of Low Voltage Current To Stimulate Bone Healing.
20979-CPT	Low	Low Intens Ultrasou Stimul To Aid Bone Healing Noninvasi, Low Intensity Ultrasound Stimulation To Aid Bone Healing Noninvasive
20985-CPT	Low	Computer-Assisted Surgical Nav, 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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CPT 20985 Fee Schedule

Compare published rates across providers.

Bayonet Point Surgery Center Ltd

Maple Lawn Surgery Center

Rye Surgical Center, LLC

Access Care Physicians Of Nj LLC

Mississippi Urology Outpatient Surgery Center, LLC