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

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 Delaware, Medicare pays $333.99 for 20205 in the office and $144.57 when it’s performed in a hospital or facility.

$333.99Office (non-facility)
$144.57Hospital or facility
−1.4%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 Delaware
  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 Delaware 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. Delaware pays $333.99. The RVUs are the same everywhere; the geographic indexes change the dollars.

20205 in Delaware vs other payment areas
  1. Delaware · this page$333.99
  2. Los Angeles, CA · California$378.54+$44.55
  3. Washington, DC area · District of Columbia$388.08+$54.09
  4. Miami, FL · Florida$381.74+$47.75
  5. Chicago, IL · Illinois$368.54+$34.55
  6. Manhattan, NY · New York$395.26+$61.27
  7. Alaska · Alaska$382.81+$48.82

Other areas in Delaware 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 Delaware 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

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 20205 in Delaware
ComponentRVULocality factorAdjusted
Physician work2.29× 1.0052.3014
Practice expense7.20× 0.9887.1136
Malpractice0.65× 0.8990.5844
Total RVUs9.9994
Conversion factor× 33.4009

Office rate, Delaware$333.99

Office: (2.29 × 1.005 + 7.2 × 0.988 + 0.65 × 0.899) × $33.4009 = $333.99

Facility: (2.29 × 1.005 + 1.46 × 0.988 + 0.65 × 0.899) × $33.4009 = $144.57

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, Delaware
Same family
20200Muscle biopsy, superficial, open approachOpen muscle biopsy at a superficial rather than deep level.$238.63
Used instead
20206Muscle biopsy, percutaneous needle approachPercutaneous needle approach for sampling muscle rather than an open approach.$207.46
Often billed with
88305Tissue pathology exam, level IV specimenMay report the separate pathologic examination of the muscle specimen.$69.66

How 20205 has changed in Delaware

20205 · Office / nonfacility

$333.99

Effective 2026-10-01

The base rate is $43.51 higher than on 2025-10-01, moving from $290.48 to $333.99 (15.0%).

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

    $290.48changed to$333.99

    • 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 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $302.53changed to$290.48

    • 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

    $297.59changed to$302.53

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $311.06changed to$297.59

    • 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 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $321.96changed to$311.06

    • 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 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $326.06changed to$321.96

    • 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

    $310.87changed to$326.06

    • 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 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $307.90changed to$310.87

    • 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 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $304.66changed to$307.90

    • 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

    $303.60changed to$304.66

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.25 changed to 5.28
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $304.14changed to$303.60

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.26 changed to 5.25
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $304.86changed to$304.14

    • 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

    $303.35changed to$304.86

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $295.91changed to$303.35

    • 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 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $302.22changed to$295.91

    • 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 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $302.22

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$333.99$144.57RVU26D
2026-07-01$333.99$144.57RVU26C
2026-04-01$333.99$144.57RVU26B
2026-01-01$333.99$144.57RVU26A
2025-10-01$290.48$150.57RVU25D
2025-07-01$290.48$150.57RVU25C
2025-04-01$290.48$150.57RVU25B
2025-01-01$290.48$150.57RVU25A
2024-10-01$302.53$154.26RVU24D
2024-07-01$302.53$154.26RVU24C
2024-04-01$302.53$154.26RVU24B
2024-03-09$302.53$154.26RVU24AR
2024-01-01$297.59$151.75RVU24A
2023-10-01$311.06$155.79RVU23D
2023-07-01$311.06$155.79RVU23C
2023-04-01$311.06$155.79RVU23B
2023-01-01$311.06$155.79RVU23A
2022-10-01$321.96$157.50RVU22D
2022-07-01$321.96$157.50RVU22C
2022-04-01$321.96$157.50RVU22B
2022-01-01$321.96$157.50RVU22A
2021-10-01$326.06$158.45RVU21D
2021-07-01$326.06$158.45RVU21C
2021-04-01$326.06$158.45RVU21B
2021-01-01$326.06$158.45RVU21A
2020-10-01$310.87$162.37RVU20D
2020-07-01$310.87$162.37RVU20C
2020-04-01$310.87$162.37RVU20B
2020-01-01$310.87$162.37RVU20A
2019-10-01$307.90$165.78RVU19D
2019-07-01$307.90$165.78RVU19C
2019-04-01$307.90$165.78RVU19B
2019-01-01$307.90$165.78RVU19A
2018-10-01$304.66$166.73RVU18D
2018-07-01$304.66$166.73RVU18C
2018-04-01$304.66$166.73RVU18B
2018-01-01$304.66$166.73RVU18AR1
2017-10-01$303.60$166.39RVU17D
2017-07-01$303.60$166.39RVU17C
2017-04-01$303.60$166.39RVU17B
2017-01-01$303.60$166.39RVU17A
2016-10-01$304.14$166.08RVU16D
2016-07-01$304.14$166.08RVU16C
2016-04-01$304.14$166.08RVU16B
2016-01-01$304.14$166.08RVU16A
2015-10-01$304.86$166.68RVU15D
2015-07-01$304.86$166.68RVU15C
2015-04-01$303.35$165.85RVU15B
2015-01-01$303.35$165.85RVU15A
2014-10-01$295.91$159.07RVU14D
2014-07-01$295.91$159.07RVU14C
2014-04-01$295.91$159.07RVU14B
2014-01-01$295.91$159.07RVU14A
2013-10-01$302.22$153.04RVU13D
2013-07-01$302.22$153.04RVU13C
2013-04-01$302.22$153.04RVU13B
2013-01-01$302.22$153.04RVU13AR

Price 20205 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

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 DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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