CPT code 20200: Muscle biopsy, superficial, open approach2026 Medicare rate & RVUs

Medicare pays $241.82 for 20200 nationally in the office and $90.18 in a hospital or facility. Local office rates run $210.16–$321.76.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 20200 covers

A physician obtains a small sample of accessible skeletal muscle through an open incision for diagnostic examination. Neurologists and surgeons may perform this procedure when evaluation of conditions such as inflammatory myopathy, muscular dystrophy, or metabolic muscle disease requires tissue. The specimen may be sent for histologic or other laboratory studies. This code describes a superficial muscle biopsy, not a needle sample or an open biopsy of a deeper muscle.

Select the code based on the muscle’s depth and the approach documented in the operative report. Documentation should identify the sampled muscle and site, the open approach, and the diagnostic reason for obtaining tissue. The 0-day global period includes same-day preoperative and postoperative care. If multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 20200 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

20200 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 20200 rate is calculated

Each of 20200’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 20200

The CMS indicators that decide how 20200 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

20200 compared with similar codes

How to choose

20205Muscle biopsyOpen deep-muscle approach

Both describe open muscle biopsy. Choose 20200 for superficial muscle and 20205 when the muscle sampled is deep.

20206Muscle biopsyPercutaneous needle approach

This code describes a percutaneous needle muscle biopsy; 20200 describes an open biopsy of superficial muscle.

Codes related to 20200

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates