FeeBase
Log inGet started
Menu

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

Reports an open biopsy of an accessible superficial skeletal muscle when tissue is needed to investigate suspected muscle disease.

CMS RVU26DEffective Oct 1, 2026One payment locality505 Medicare services in 2024

In Puerto Rico, Medicare pays $243.64 for 20200 in the office and $90.33 when it’s performed in a hospital or facility.

$243.64Office (non-facility)
$90.33Hospital or facility
+0.8%vs the national office rate ($241.82)

Check a contract rate as a % of Medicare · 20200 nationwide

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

We’ll open 20200 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 20200 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Puerto Rico compares for 20200

Across 109 of 109 payment localities, the office rate for 20200 runs from $210.16 in Arkansas to $321.76 in San Benito County, CA. Puerto Rico pays $243.64. The RVUs are the same everywhere; the geographic indexes change the dollars.

20200 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$243.64
  2. Los Angeles, CA · California$272.93+$29.29
  3. Washington, DC area · District of Columbia$278.18+$34.54
  4. Miami, FL · Florida$268.18+$24.54
  5. Chicago, IL · Illinois$259.07+$15.43
  6. Manhattan, NY · New York$281.59+$37.95
  7. Alaska · Alaska$271.82+$28.18

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

20200 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$213.70$81.02
ArkansasArkansas$210.16$79.90
ArizonaArizona$234.40$87.46
Bakersfield, CACalifornia$255.37$89.17
Chico, CACalifornia$254.37$88.17
El Centro, CACalifornia$254.43$88.23
Fresno, CACalifornia$254.37$88.17
Hanford, CACalifornia$254.37$88.17

20200 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$210.16

$288.07

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
20200 office rate range by state
State / territoryOffice rate rangeLocalities
AK$271.821
AL$213.701
AR$210.161
AZ$234.401
CA$254.37–$321.7629
CO$251.341
CT$259.381
DC$278.181
DE$238.631
FL$240.03–$268.183
GA$224.54–$247.362
GU$261.561
HI$261.561
IA$218.901
ID$220.751
IL$232.94–$259.074
IN$222.181
KS$218.221
KY$220.571
LA$220.37–$232.762
MA$249.72–$277.722
MD$243.47–$278.183
ME$222.59–$235.622
MI$227.58–$243.932
MN$238.401
MO$216.38–$233.113
MS$213.291
MT$241.801
NC$225.161
ND$234.481
NE$220.121
NH$247.741
NJ$261.67–$274.782
NM$229.201
NV$239.941
NY$229.05–$289.855
OH$226.081
OK$219.591
OR$237.42–$259.622
PA$226.22–$252.522
PR$243.641
RI$247.401
SC$226.131
SD$233.621
TN$219.541
TX$224.56–$251.078
UT$229.641
VA$235.09–$278.182
VI$243.641
VT$233.901
WA$249.13–$283.252
WI$225.631
WV$223.301
WY$238.611

See 20200 in every payment locality

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.

How the rate is built · 20200

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.42

1.42 RVUs× 1.000 GPCI

Practice expense5.45

5.45 RVUs× 1.000 GPCI

Malpractice0.37

0.37 RVUs× 1.000 GPCI

Adjusted RVUs

7.2400

Conversion factor

$33.4009

Medicare rate

$241.82

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,727

Code
20200
Physician work
1.42
Practice expense
5.45
Malpractice
0.37

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 20200 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.42× 1.0001.4200
Practice expense5.45× 1.0115.5099
Malpractice0.37× 0.9850.3644
Total RVUs7.2944
Conversion factor× 33.4009

Office rate, Puerto Rico$243.64

Office: (1.42 × 1 + 5.45 × 1.011 + 0.37 × 0.985) × $33.4009 = $243.64

Facility: (1.42 × 1 + 0.91 × 1.011 + 0.37 × 0.985) × $33.4009 = $90.33

Open 20200 in the RVU calculator

Payment rules and modifiers for 20200

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

CMS payment indicators · 20200

Muscle biopsy, superficial, open approach

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

20200 without 51 · national office

$241.82

Muscle biopsy, superficial, open approach

20200-51 · Second procedure: 50%

$120.91

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 20200

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

Codes related to 20200
CodeHow it relatesOffice range, Puerto Rico
Same family
20205Muscle biopsy, open deep-muscle approachOpen muscle biopsy when the sampled muscle is deep rather than superficial.$341.00
Used instead
20206Muscle biopsy, percutaneous needle approachPercutaneous needle approach for obtaining a muscle biopsy specimen.$211.61
Often billed with
88305Tissue pathology exam, level IV specimenMay be reported by the laboratory for pathologic examination of the muscle specimen.$70.63

How 20200 has changed in Puerto Rico

20200 · Office / nonfacility

$243.64

Effective 2026-10-01

The base rate is $35.16 higher than on 2025-10-01, moving from $208.48 to $243.64 (16.9%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $208.48changed to$243.64

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.46 changed to 1.42
    • Practice expense RVU 4.58 changed to 5.45
    • Malpractice RVU 0.38 changed to 0.37
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $217.24changed to$208.48

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.67 changed to 4.58
    • Malpractice RVU 0.37 changed to 0.38

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $213.69changed to$217.24

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $223.72changed to$213.69

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.74 changed to 4.67
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $222.64changed to$223.72

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $230.95changed to$222.64

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.83 changed to 4.74
    • Malpractice RVU 0.35 changed to 0.37
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $234.63changed to$230.95

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.89 changed to 4.83
    • Malpractice RVU 0.34 changed to 0.35

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $220.14changed to$234.63

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.26 changed to 4.89
    • Malpractice RVU 0.35 changed to 0.34
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $215.34changed to$220.14

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.13 changed to 4.26
    • Malpractice RVU 0.36 changed to 0.35
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $212.93changed to$215.34

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.07 changed to 4.13

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $185.96changed to$212.93

    • Conversion factor 35.8887 changed to 35.9996
    • Malpractice RVU 0.37 changed to 0.36
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $158.89changed to$185.96

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $159.72changed to$158.89

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.08 changed to 4.07

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $158.92changed to$159.72

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $155.56changed to$158.92

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.04 changed to 4.08
    • Malpractice RVU 0.32 changed to 0.37
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $156.27changed to$155.56

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.50 changed to 4.04
    • Malpractice RVU 0.33 changed to 0.32
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $156.27

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$243.64$90.33RVU26D
2026-07-01$243.64$90.33RVU26C
2026-04-01$243.64$90.33RVU26B
2026-01-01$243.64$90.33RVU26A
2025-10-01$208.48$93.82RVU25D
2025-07-01$208.48$93.82RVU25C
2025-04-01$208.48$93.82RVU25B
2025-01-01$208.48$93.82RVU25A
2024-10-01$217.24$95.22RVU24D
2024-07-01$217.24$95.22RVU24C
2024-04-01$217.24$95.22RVU24B
2024-03-09$217.24$95.22RVU24AR
2024-01-01$213.69$93.67RVU24A
2023-10-01$223.72$95.97RVU23D
2023-07-01$222.64$95.90RVU23C
2023-04-01$222.64$95.90RVU23B
2023-01-01$222.64$95.90RVU23A
2022-10-01$230.95$96.65RVU22D
2022-07-01$230.95$96.65RVU22C
2022-04-01$230.95$96.65RVU22B
2022-01-01$230.95$96.65RVU22A
2021-10-01$234.63$96.41RVU21D
2021-07-01$234.63$96.41RVU21C
2021-04-01$234.63$96.41RVU21B
2021-01-01$234.63$96.41RVU21A
2020-10-01$220.14$98.64RVU20D
2020-07-01$220.14$98.64RVU20C
2020-04-01$220.14$98.64RVU20B
2020-01-01$220.14$98.64RVU20A
2019-10-01$215.34$98.49RVU19D
2019-07-01$215.34$98.49RVU19C
2019-04-01$215.34$98.49RVU19B
2019-01-01$215.34$98.49RVU19A
2018-10-01$212.93$98.74RVU18D
2018-07-01$212.93$98.74RVU18C
2018-04-01$212.93$98.74RVU18B
2018-01-01$212.93$98.74RVU18AR1
2017-10-01$185.96$89.49RVU17D
2017-07-01$185.96$89.49RVU17C
2017-04-01$185.96$89.49RVU17B
2017-01-01$185.96$89.49RVU17A
2016-10-01$158.89$79.63RVU16D
2016-07-01$158.89$79.63RVU16C
2016-04-01$158.89$79.63RVU16B
2016-01-01$158.89$79.63RVU16A
2015-10-01$159.72$79.92RVU15D
2015-07-01$159.72$79.92RVU15C
2015-04-01$158.92$79.52RVU15B
2015-01-01$158.92$79.52RVU15A
2014-10-01$155.56$78.71RVU14D
2014-07-01$155.56$78.71RVU14C
2014-04-01$155.56$78.71RVU14B
2014-01-01$155.56$78.71RVU14A
2013-10-01$156.27$76.00RVU13D
2013-07-01$156.27$76.00RVU13C
2013-04-01$156.27$76.00RVU13B
2013-01-01$156.27$76.00RVU13AR

Price 20200 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

20200 billing questions

How does this differ from 20205?

Use 20200 for an open biopsy of superficial muscle. Code 20205 describes an open biopsy of deep muscle.

When is 20206 more appropriate?

Code 20206 describes a percutaneous needle muscle biopsy. Use 20200 when the documented method is an open biopsy of superficial muscle.

Can modifier 50 be used for biopsies on both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

Is same-day postoperative care separately included?

The code has a 0-day global period, which includes same-day preoperative and postoperative care.

Can an assistant or co-surgeon report this procedure?

Medicare does not pay an assistant-at-surgery claim for 20200. Co-surgeons and team surgery are not permitted.

What documentation supports reporting 20200?

The operative report should identify the muscle and site, establish that the biopsy was open and superficial, and state why tissue was obtained.

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

Show the CMS file lines behind this rate
RVUs for 20200PPRRVU2026_Oct_nonQPP.csv, line 1,727 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 20200 pays in Puerto Rico?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 20200 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Build my fee sheet