CPT code 20200: Muscle biopsy, superficial, open approach2026 Medicare rate & RVUs in Texas
Reports an open biopsy of an accessible superficial skeletal muscle when tissue is needed to investigate suspected muscle disease.
Medicare pays $224.56–$251.07 for 20200 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$224.56 to $251.07
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $251.07 | $90.63 |
| Beaumont, TX | $224.56 | $86.57 |
| Brazoria, TX | $237.84 | $87.57 |
| Dallas, TX | $239.77 | $88.73 |
| Fort Worth, TX | $238.11 | $88.59 |
| Galveston, TX | $238.80 | $88.22 |
| Houston, TX | $245.57 | $95.00 |
| Rest of Texas | $231.34 | $87.43 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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%).
20200 compared with similar codes
Compare codes · National
20200 vs 20205 vs 20206: Medicare rates
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.
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
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