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See a sample rate comparisonCPT 21920 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.
Biopsy Of Tissue Under Skin, A Procedure To Remove A Sample Of Soft Tissue From Near The Skin Surface For Testing (Biopsy).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11 - Office None |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21920 |
| Medicaid Fee Schedule | View Medicaid rates for 21920 |
National average reimbursement for CPT 21920 by major payers:
$330.83
$332.30
$345.23
$408.90
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CPT 21920
5 of 25 sample ratesHigher to lower in this preview
Surgicare Of St Andrews Ltd
$4,215.00Published rateCentral Park Endoscopy Center LLC, Endoscopy Center At Central Park
Central Park Endoscopy Center LLC
$774.00Published rateWestern Washington Endoscopy Centers LLC, Sunrise Endoscopy Center
Western Washington Endoscopy Centers LLC
$499.00Published rateChicago Prostate Cancer Surgery Center, LLC, Dupage Medical Group Surgery Center, Westmont
Chicago Prostate Cancer Surgery Center LLC
$414.00Published rateStanley Cobham
Deaconess Hospital Inc
$205.44Published rate
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See a sample payer proposalCPT 21920 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21920 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 21920 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 |
|---|---|---|
| 21920-CPT | Moderate | Biopsy Of Tissue Under Skin, A Procedure To Remove A Sample Of Soft Tissue From Near The Skin Surface For Testing (Biopsy). |
| 21925-CPT | Moderate | Biopsy Back/Flank Deep |
| 21930-CPT | Moderate | Xcision Tumor Sft Tissue Of Bck Or Flank Subcutane Less Than, Excision Tumor Soft Tissue Of Back Or Flank Subcutaneous; Less Than |
| 21931-CPT | Moderate | Xcision Tumor Sft Tissue Of Bck Or Flank Subcutane 3 Cm Or G, Excision Tumor Soft Tissue Of Back Or Flank Subcutaneous; 3 Cm Or G |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21920. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21920 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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