How do Medicare & Medicaid rates influence fee schedules?

Medicare & Medicaid rates are government-set reimbursement amounts that directly influence the fee schedules for services like CPT 59820.

How do private insurance rates affect fee schedules?

Private insurance rates are negotiated between healthcare providers and insurance companies, which significantly impact the overall fee schedule for medical services.

How does geographic location affect fee schedules?

Geographic location can affect fee schedules, with costs often being higher in urban areas compared to rural or less densely populated regions.

How does provider type affect fee schedules?

The type of provider can influence fee schedules, with hospital providers potentially having different rates compared to those in private practice.

A CPT (Current Procedural Terminology) code is a five-digit numerical code used by medical professionals to describe medical, surgical, and diagnostic services. These codes are essential for billing and insurance purposes, providing a standardized way to communicate what services a patient received.

How can I find the cost of a medical procedure?

Finding the exact cost of a medical procedure can be complex due to various factors like your specific insurance plan, the provider's rates, and your geographic location. To get an estimate, you can contact your insurance company or the healthcare provider directly. For a more direct way to look up fee schedules based on a CPT code and your specific location, you can use tools like Payerprice.

Why is it difficult to know healthcare costs upfront?

Healthcare costs are often opaque due to several factors: negotiated rates between providers and insurance companies, complex billing practices, variations in pricing based on geographic location and facility type, and the individual patient's insurance coverage and deductible status. This complexity makes it challenging to get a clear, upfront price.

What is the difference between an in-network and out-of-network provider?

An in-network provider has a contract with your health insurance plan to provide services at pre-negotiated rates, typically resulting in lower out-of-pocket costs for you. An out-of-network provider does not have such a contract, meaning you may pay a higher percentage of the cost, or even the full cost, until your deductible is met.

Where can I find specific fee schedule information for a CPT code in my location?

For specific fee schedule information related to a CPT code in your particular location, it's recommended to use a specialized tool. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and specific location to find relevant pricing data.

CPT 59820 Fee Schedule

Q: What factors affect fee schedules?

Fee schedules are affected by 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), and Provider Type (hospital providers may have different rates than private practice).

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.

Surgery For Miscarriage, When A Pregnancy Ends Spontaneously Without Going To Term The Event Is Called A Miscarriage. Material Remaining In The Uterus Is Removed As Quickly As Possible Especially If Infection Is Present.

Key Fact	Detail
Service Type	Surgery Surgical Procedures for Maternity Care and Delivery
Common Place of Service	22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center
Common Modifiers	None AG - Primary physician GC - Service performed by resident under supervision
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 59820
Medicaid Fee Schedule	View Medicaid rates for 59820

National average reimbursement for CPT 59820 by major payers:

$498.02

$522.66

$571.71

$597.09

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 59820.

CPT 59820

5 of 25 sample ratesHigher to lower in this preview

Joshua Benham
CAObstetrics & Gynecology PhysicianNPI 1528406881Tax ID 94-3281660
$2,379.95Published rate
Laura Mccurdy
Florida Woman Care, LLC
FLObstetrics & Gynecology PhysicianNPI 1336309491Tax ID 26-0609255
$839.59Published rate
Hans Jean-Baptiste
University Of Maryland Community Medical Group Inc
FLObstetrics & Gynecology PhysicianNPI 1437332269Tax ID 52-1874111
$703.02Published rate
Nathalie Castillo
Allara Medical Group PA
FLObstetrics & Gynecology PhysicianNPI 1568491355Tax ID 86-1437075
$456.38Published rate
Steven Pliskow
Ackerman Pliskow Md PA
FLObstetrics & Gynecology PhysicianNPI 1659418614Tax ID 59-2511828
$305.85Published 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 59820 vs. Other Surgical Procedures for Maternity Care and Delivery Codes

The CPT 59820 code is part of the Surgery services used for Surgical Procedures for Maternity Care and Delivery. 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 59820 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
59812-CPT	Moderate	Surgery For Miscarriage, When A Pregnancy Ends Spontaneously Without Going To Term The Event Is Called A Miscarriage. Material Remaining In The Uterus Is Removed As Quickly As Possible Especially If Infection Is Present.
59820-CPT	Moderate	Surgery For Miscarriage, When A Pregnancy Ends Spontaneously Without Going To Term The Event Is Called A Miscarriage. Material Remaining In The Uterus Is Removed As Quickly As Possible Especially If Infection Is Present.
59821-CPT	Moderate	Surgery For Miscarriage, When A Pregnancy Ends Spontaneously Without Going To Term The Event Is Called A Miscarriage. Material Remaining In The Uterus Is Removed As Quickly As Possible Especially If Infection Is Present.
59840-CPT	Moderate	Termination Of A Pregnancy, Procedure To Terminate A Pregnancy. Involves Dilating (Opening) The Cervix And Removing The Contents Of The Uterus By Scraping Or Suction.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 59820. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 59820 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 59820 Fee Schedule

Compare published rates across providers.

Joshua Benham

Laura Mccurdy

Hans Jean-Baptiste

Nathalie Castillo

Steven Pliskow