Aspirate/inj ganglion cyst
Ganglion cyst drainage or injection procedures show an 8.0x price variation between Medicare facility rates ($36.92) and hospital outpatient charges ($295.19), making bill verification essential.
About the analyst
Elena Vasquez leads hospital billing pattern analysis at BillRazor Research. She focuses on identifying overcharges, markup outliers, and patient advocacy strategies. Expertise: hospital billing patterns, overcharge analysis, patient advocacy.
Code 20612 covers the drainage of fluid from or injection of medication into a ganglion cyst using a needle. Patients with painful or limiting cysts on joints or tendons typically receive this procedure. Medicare reimburses approximately $150 for this code, though facility charges can reach 8-12 times this benchmark amount.
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Common billing errors
Common billing errors in musculoskeletal procedures often involve confusion between arthroscopy codes (29800-29999 series) and open joint procedures (27000-28000 series), where providers may bill the higher-reimbursed open procedure when arthroscopic methods were used. Unbundling frequently occurs with injection procedures, where separate billing for imaging guidance (such as fluoroscopy code 77002) appears alongside joint injection codes that already include guidance in their description. Duplicate charges emerge when both diagnostic and therapeutic arthroscopy codes are billed for the same joint during a single session, despite Medicare's bundling rules. Physical therapy evaluation codes (97161-97163) are commonly duplicated across multiple sessions when only initial evaluations warrant these specific codes. Patients should verify that hardware removal procedures aren't billed separately when performed during the same operative session as implant placement, as these combinations often represent charges above the benchmark for standard bundled procedures. Documentation should clearly support any bilateral procedure modifiers that significantly increase reimbursement rates.
Facility rate
$37
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
4
24 data points
Key insights for CPT 20612
ASC vs hospital outpatient savings
$257Having this done at an ambulatory surgery center costs $38 vs $295 at a hospital outpatient
Facility vs office setting
$62 differenceFacility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $37 | Lowest |
| Non-facility (office) | $99 | +168% |
| Outpatient (APC) | $295 | +700% |
| Ambulatory surgery (ASC) | $38 | +3% |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Related procedures
FAQ — Bones, Joints & Muscles billing
What is the typical Medicare reimbursement range for musculoskeletal procedures?
How many different musculoskeletal procedures does Medicare cover?
What should I expect for billing variations in musculoskeletal procedures?
How does the average Medicare rate compare across the musculoskeletal procedure category?
Related pricing data
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use