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CPT code 20205: Muscle biopsy, open deep-muscle approach2026 Medicare rate & RVUs in Connecticut

Reports open sampling of deep muscle tissue for diagnostic evaluation when a superficial sample or percutaneous needle approach is not the method performed.

CMS RVU26DEffective Oct 1, 2026One payment locality2K Medicare services in 2024

In Connecticut, Medicare pays $363.29 for 20205 in the office and $156.81 when it’s performed in a hospital or facility.

$363.29Office (non-facility)
$156.81Hospital or facility
+7.3%vs the national office rate ($338.69)

Check a contract rate as a % of Medicare · 20205 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 20205 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 20205 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 20205 covers

The clinician obtains a muscle specimen through an incision that reaches deep muscle tissue. This approach may be selected when evaluation of suspected neuromuscular disease requires tissue for laboratory examination and a needle sample is not performed. A surgeon commonly performs the procedure in a hospital or ambulatory surgery setting; the specimen is sent for pathologic evaluation.

Select this code for an open biopsy of deep muscle, not a superficial muscle sample or percutaneous needle biopsy. The operative note should identify the muscle sampled and document the open approach and depth. Same-day preoperative and postoperative care is included in the 0-day global period. When other procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this descriptor and anatomy. Medicare does not pay an assistant at surgery for this code; 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 Connecticut compares for 20205

Across 109 of 109 payment localities, the office rate for 20205 runs from $294.25 in Arkansas to $443.32 in San Benito County, CA. Connecticut pays $363.29. The RVUs are the same everywhere; the geographic indexes change the dollars.

20205 in Connecticut vs other payment areas
  1. Connecticut · this page$363.29
  2. Los Angeles, CA · California$378.54+$15.25
  3. Washington, DC area · District of Columbia$388.08+$24.79
  4. Miami, FL · Florida$381.74+$18.45
  5. Chicago, IL · Illinois$368.54+$5.25
  6. Manhattan, NY · New York$395.26+$31.97
  7. Alaska · Alaska$382.81+$19.52

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

Every other payment area

20205 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$299.20$131.45
ArkansasArkansas$294.25$129.56
ArizonaArizona$328.10$142.33
Bakersfield, CACalifornia$354.74$144.61
Chico, CACalifornia$353.00$142.87
El Centro, CACalifornia$353.11$142.98
Fresno, CACalifornia$353.00$142.87
Hanford, CACalifornia$353.00$142.87

20205 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.

$294.25

$398.16

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

View every state and territory as a table
20205 office rate range by state
State / territoryOffice rate rangeLocalities
AK$382.811
AL$299.201
AR$294.251
AZ$328.101
CA$353.00–$443.3229
CO$350.241
CT$363.291
DC$388.081
DE$333.991
FL$339.02–$381.743
GA$316.88–$347.132
GU$362.491
HI$362.491
IA$305.151
ID$308.001
IL$329.99–$368.544
IN$309.971
KS$304.831
KY$310.151
LA$310.12–$327.452
MA$348.25–$386.092
MD$340.56–$388.083
ME$311.24–$328.512
MI$320.56–$345.162
MN$330.371
MO$304.93–$327.193
MS$299.591
MT$338.641
NC$314.741
ND$325.791
NE$306.661
NH$345.831
NJ$365.98–$383.462
NM$323.091
NV$335.301
NY$320.21–$407.645
OH$317.941
OK$308.111
OR$331.28–$361.052
PA$317.77–$354.112
PR$341.001
RI$345.731
SC$317.151
SD$324.271
TN$306.751
TX$315.50–$350.318
UT$322.041
VA$328.21–$388.082
VI$341.001
VT$325.561
WA$347.24–$393.132
WI$313.561
WV$316.541
WY$333.041

See 20205 in every payment locality

How the 20205 rate is calculated

Each of 20205’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 · 20205

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.29

2.29 RVUs× 1.000 GPCI

Practice expense7.20

7.20 RVUs× 1.000 GPCI

Malpractice0.65

0.65 RVUs× 1.000 GPCI

Adjusted RVUs

10.1400

Conversion factor

$33.4009

Medicare rate

$338.69

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

The exact Connecticut inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,728

Code
20205
Physician work
2.29
Practice expense
7.20
Malpractice
0.65

GPCI2026.csv

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 20205 in Connecticut
ComponentRVULocality factorAdjusted
Physician work2.29× 1.0202.3358
Practice expense7.20× 1.0777.7544
Malpractice0.65× 1.2100.7865
Total RVUs10.8767
Conversion factor× 33.4009

Office rate, Connecticut$363.29

Office: (2.29 × 1.02 + 7.2 × 1.077 + 0.65 × 1.21) × $33.4009 = $363.29

Facility: (2.29 × 1.02 + 1.46 × 1.077 + 0.65 × 1.21) × $33.4009 = $156.81

Open 20205 in the RVU calculator

Payment rules and modifiers for 20205

The CMS indicators that decide how 20205 is paid alongside other services.

CMS payment indicators · 20205

Muscle biopsy, open deep-muscle 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

20205 without 51 · national office

$338.69

Muscle biopsy, open deep-muscle approach

20205-51 · Second procedure: 50%

$169.35

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 20205

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

Codes related to 20205
CodeHow it relatesOffice range, Connecticut
Same family
20200Muscle biopsy, superficial, open approachOpen muscle biopsy at a superficial rather than deep level.$259.38
Used instead
20206Muscle biopsy, percutaneous needle approachPercutaneous needle approach for sampling muscle rather than an open approach.$224.55
Often billed with
88305Tissue pathology exam, level IV specimenMay report the separate pathologic examination of the muscle specimen.$74.24

How 20205 has changed in Connecticut

20205 · Office / nonfacility

$363.29

Effective 2026-10-01

The base rate is $47.11 higher than on 2025-10-01, moving from $316.18 to $363.29 (14.9%).

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

    $316.18changed to$363.29

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.35 changed to 2.29
    • Practice expense RVU 6.05 changed to 7.20
    • Malpractice RVU 0.64 changed to 0.65
    • Work GPCI 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $329.45changed to$316.18

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.14 changed to 6.05
    • Malpractice RVU 0.66 changed to 0.64

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $324.07changed to$329.45

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $335.63changed to$324.07

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.16 changed to 6.14
    • Malpractice RVU 0.65 changed to 0.66
    • Work GPCI 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $344.55changed to$335.63

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.23 changed to 6.16
    • Malpractice RVU 0.62 changed to 0.65
    • Work GPCI 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $348.96changed to$344.55

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.27 changed to 6.23

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $332.69changed to$348.96

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.52 changed to 6.27
    • Malpractice RVU 0.60 changed to 0.62
    • Work GPCI 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $330.17changed to$332.69

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.37 changed to 5.52
    • Malpractice RVU 0.63 changed to 0.60
    • Work GPCI 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $326.66changed to$330.17

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.28 changed to 5.37
    • Malpractice RVU 0.64 changed to 0.63

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $325.31changed to$326.66

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.25 changed to 5.28
    • Work GPCI 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $325.51changed to$325.31

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.26 changed to 5.25
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $326.28changed to$325.51

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.25 changed to 5.26

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $324.66changed to$326.28

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $318.36changed to$324.66

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.21 changed to 5.25
    • Malpractice RVU 0.54 changed to 0.64
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $327.09changed to$318.36

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.87 changed to 5.21
    • Malpractice RVU 0.56 changed to 0.54
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $327.09

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$363.29$156.81RVU26D
2026-07-01$363.29$156.81RVU26C
2026-04-01$363.29$156.81RVU26B
2026-01-01$363.29$156.81RVU26A
2025-10-01$316.18$162.31RVU25D
2025-07-01$316.18$162.31RVU25C
2025-04-01$316.18$162.31RVU25B
2025-01-01$316.18$162.31RVU25A
2024-10-01$329.45$166.39RVU24D
2024-07-01$329.45$166.39RVU24C
2024-04-01$329.45$166.39RVU24B
2024-03-09$329.45$166.39RVU24AR
2024-01-01$324.07$163.67RVU24A
2023-10-01$335.63$165.72RVU23D
2023-07-01$335.63$165.72RVU23C
2023-04-01$335.63$165.72RVU23B
2023-01-01$335.63$165.72RVU23A
2022-10-01$344.55$165.28RVU22D
2022-07-01$344.55$165.28RVU22C
2022-04-01$344.55$165.28RVU22B
2022-01-01$344.55$165.28RVU22A
2021-10-01$348.96$166.27RVU21D
2021-07-01$348.96$166.27RVU21C
2021-04-01$348.96$166.27RVU21B
2021-01-01$348.96$166.27RVU21A
2020-10-01$332.69$170.81RVU20D
2020-07-01$332.69$170.81RVU20C
2020-04-01$332.69$170.81RVU20B
2020-01-01$332.69$170.81RVU20A
2019-10-01$330.17$175.08RVU19D
2019-07-01$330.17$175.08RVU19C
2019-04-01$330.17$175.08RVU19B
2019-01-01$330.17$175.08RVU19A
2018-10-01$326.66$176.14RVU18D
2018-07-01$326.66$176.14RVU18C
2018-04-01$326.66$176.14RVU18B
2018-01-01$326.66$176.14RVU18AR1
2017-10-01$325.31$175.78RVU17D
2017-07-01$325.31$175.78RVU17C
2017-04-01$325.31$175.78RVU17B
2017-01-01$325.31$175.78RVU17A
2016-10-01$325.51$175.40RVU16D
2016-07-01$325.51$175.40RVU16C
2016-04-01$325.51$175.40RVU16B
2016-01-01$325.51$175.40RVU16A
2015-10-01$326.28$176.03RVU15D
2015-07-01$326.28$176.03RVU15C
2015-04-01$324.66$175.16RVU15B
2015-01-01$324.66$175.16RVU15A
2014-10-01$318.36$171.24RVU14D
2014-07-01$318.36$171.24RVU14C
2014-04-01$318.36$171.24RVU14B
2014-01-01$318.36$171.24RVU14A
2013-10-01$327.09$168.47RVU13D
2013-07-01$327.09$168.47RVU13C
2013-04-01$327.09$168.47RVU13B
2013-01-01$327.09$168.47RVU13AR

Price 20205 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

20205 billing questions

How is this distinguished from a superficial muscle biopsy?

Use 20205 when the open approach reaches deep muscle tissue. A superficial muscle sample is reported with 20200.

How does this differ from a percutaneous muscle biopsy?

This code describes an open approach to deep muscle. Use 20206 when the muscle is sampled percutaneously with a needle.

Is the pathology examination included?

The code reports obtaining the muscle specimen. A pathologist may separately report the tissue examination, such as 88305, when that service is performed and documented.

Can modifier 50 be used for biopsies on both sides?

Modifier 50 is inappropriate for this descriptor and anatomy, so do not report a bilateral adjustment.

Can an assistant surgeon or co-surgeon be reported?

Medicare does not pay an assistant at surgery for 20205. Co-surgeon and team-surgery reporting are not permitted.

What same-session payment reduction should the billing team expect?

When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure payment.

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 20205PPRRVU2026_Oct_nonQPP.csv, line 1,728 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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