CPT 56420

What Washington hospitals publish for this code

Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Doctor's fee, Seattle (King County)

$212 in an office; $111 in a hospital or surgery center

Doctor's fee, rest of Washington

$187 in an office; $101 in a hospital or surgery center

Hospital outpatient payment (national)

$207 (APC 5411)

Surgery center payment (national)

$112

How hospitals also write this code

Some price files write it differently. These are counted as CPT 56420:

• 56420P (with a letter after it, P; 6 price lines)
• 56420T (with a letter after it, T; 3 price lines)