HCPCS G0289

Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee

Current codeArthroscopy - Lower Extremity21 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid (state program): Washington Apple Health fee-for-service. Applies only to Medicaid enrollees.

Prices for HCPCS G0289 by hospital
Hospital	Medicaid (state program) rates (lowest – highest)	Cash price	List price (before discounts)
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01	—	$31.33 – $154Doctor’s fee: $125 – $157	$48.20 – $237Doctor’s fee: $193 – $241
Seattle Children's HospitalSeattle	—	—	$52.80 – $264
Three Rivers HospitalBrewster	Doctor’s fee: $54.60 – $878	Doctor’s fee: $78.00 – $1,254	Doctor’s fee: $78.00 – $1,254
Virginia Mason Medical CenterSeattle	—	$1,111	$2,178

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): $76.86 in a hospital or surgery center
Doctor's fee, rest of Washington: $71.92 in a hospital or surgery center

How hospitals also write this code

Some price files write it differently. These are counted as HCPCS G0289:

G0289P (with a letter after it, P; 2 price lines)
G0289T (with a letter after it, T; 1 price line)