CPT code 20220: Bone biopsy, trocar or needle, superficial2026 Medicare rate & RVUs in Puerto Rico

A clinician obtains a sample from an anatomically superficial bone with a trocar or needle to evaluate suspected infection, neoplasm, or other bone disease.

CMS RVU26DEffective Oct 1, 2026One payment locality11.6K Medicare services in 2024

In Puerto Rico, Medicare pays $224.83 for 20220 in the office and $76.59 when it’s performed in a hospital or facility.

$224.83Office (non-facility)
$76.59Hospital or facility
+0.8%vs the national office rate ($223.12)

Check a contract rate as a % of Medicare · 20220 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 20220 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 20220 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 20220 covers

Code 20220 describes sampling bone through a trocar or biopsy needle at a site classified as superficial, rather than exposing bone through an open incision. Typical targets include the ilium, sternum, ribs, and spinous processes. The service may be performed by an interventional radiologist, orthopedic surgeon, or another clinician experienced in percutaneous bone sampling, often in an imaging or procedure suite; it may also be performed in an office setting when appropriate. The purpose may be to investigate a focal lesion, suspected bone infection, or unexplained abnormality and provide tissue for pathology or microbiology.

Choose 20220 based on the bone-site category and needle or trocar approach; use 20225 for a deep site and an open bone-biopsy code when bone is exposed surgically. Documentation should identify the target bone, approach, specimen obtained, and clinical indication. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is statutorily restricted, and co-surgeon and team-surgery reporting 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 20220

Across 109 of 109 payment localities, the office rate for 20220 runs from $197.29 in Arkansas to $298.74 in San Benito County, CA. Puerto Rico pays $224.83. The RVUs are the same everywhere; the geographic indexes change the dollars.

20220 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$224.83
  2. Los Angeles, CA · California$253.37+$28.54
  3. Washington, DC area · District of Columbia$255.80+$30.97
  4. Miami, FL · Florida$238.51+$13.68
  5. Chicago, IL · Illinois$231.67+$6.84
  6. Manhattan, NY · New York$256.40+$31.57
  7. Alaska · Alaska$258.09+$33.26

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

Every other payment area

20220 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$200.20$71.89
ArkansasArkansas$197.29$71.33
ArizonaArizona$217.23$75.14
Bakersfield, CACalifornia$237.63$76.92
Chico, CACalifornia$237.11$76.40
El Centro, CACalifornia$237.14$76.43
Fresno, CACalifornia$237.11$76.40
Hanford, CACalifornia$237.11$76.40

20220 rates by state

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

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.

$197.29

$267.93

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

View every state and territory as a table
20220 office rate range by state
State / territoryOffice rate rangeLocalities
AK$258.091
AL$200.201
AR$197.291
AZ$217.231
CA$237.11–$298.7429
CO$232.991
CT$237.991
DC$255.801
DE$220.851
FL$218.77–$238.513
GA$206.53–$227.042
GU$243.151
HI$243.151
IA$205.781
ID$207.031
IL$212.08–$232.304
IN$208.251
KS$204.591
KY$204.471
LA$204.06–$214.232
MA$231.50–$256.452
MD$225.15–$255.803
ME$207.88–$219.552
MI$209.61–$221.282
MN$223.871
MO$200.38–$215.273
MS$198.891
MT$223.111
NC$210.101
ND$219.751
NE$206.981
NH$229.121
NJ$240.88–$253.082
NM$210.681
NV$222.331
NY$213.25–$262.365
OH$208.921
OK$204.341
OR$220.78–$240.692
PA$209.39–$231.892
PR$224.831
RI$228.931
SC$209.831
SD$219.351
TN$205.601
TX$207.99–$232.078
UT$212.721
VA$218.67–$255.802
VI$224.831
VT$218.681
WA$231.13–$261.922
WI$212.311
WV$204.131
WY$221.641

See 20220 in every payment locality

How the 20220 rate is calculated

Each of 20220’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 · 20220

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.61

1.61 RVUs× 1.000 GPCI

Practice expense4.90

4.90 RVUs× 1.000 GPCI

Malpractice0.17

0.17 RVUs× 1.000 GPCI

Adjusted RVUs

6.6800

Conversion factor

$33.4009

Medicare rate

$223.12

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

1,732

Code
20220
Physician work
1.61
Practice expense
4.90
Malpractice
0.17

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 20220 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.61× 1.0001.6100
Practice expense4.90× 1.0114.9539
Malpractice0.17× 0.9850.1675
Total RVUs6.7313
Conversion factor× 33.4009

Office rate, Puerto Rico$224.83

Office: (1.61 × 1 + 4.9 × 1.011 + 0.17 × 0.985) × $33.4009 = $224.83

Facility: (1.61 × 1 + 0.51 × 1.011 + 0.17 × 0.985) × $33.4009 = $76.59

Open 20220 in the RVU calculator

Payment rules and modifiers for 20220

The CMS indicators that decide how 20220 is paid alongside other services.

CMS payment indicators · 20220

Bone biopsy, trocar or needle, superficial

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

20220 without 51 · national office

$223.12

Bone biopsy, trocar or needle, superficial

20220-51 · Second procedure: 50%

$111.56

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

How 20220 has changed in Puerto Rico

20220 · Office / nonfacility

$224.83

Effective 2026-10-01

The base rate is $3.84 higher than on 2025-10-01, moving from $220.99 to $224.83 (1.7%).

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

    $220.99changed to$224.83

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.65 changed to 1.61
    • Practice expense RVU 4.99 changed to 4.90
    • Malpractice RVU 0.16 changed to 0.17
    • 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

    $231.78changed to$220.99

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.12 changed to 4.99

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $228.00changed to$231.78

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $241.60changed to$228.00

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.27 changed to 5.12
    • Malpractice RVU 0.17 changed to 0.16
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982
  5. October 1, 2023

    RVU23D

    $240.26changed to$241.60

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984
  6. January 1, 2023

    RVU23A

    $249.90changed to$240.26

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.39 changed to 5.27
    • Malpractice RVU 0.14 changed to 0.17
    • 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

    $259.00changed to$249.90

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.58 changed to 5.39
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $255.53changed to$259.00

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.26 changed to 5.58
    • Malpractice RVU 0.13 changed to 0.15
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $173.45changed to$255.53

    • Conversion factor 36.0391 changed to 36.0896
    • Work RVU 1.27 changed to 1.65
    • Practice expense RVU 3.41 changed to 5.26
    • Malpractice RVU 0.11 changed to 0.13
    • 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

    $172.53changed to$173.45

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.39 changed to 3.41

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $152.26changed to$172.53

    • Conversion factor 35.8887 changed to 35.9996
    • 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

    $132.81changed to$152.26

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.41 changed to 3.39
    • Malpractice RVU 0.12 changed to 0.11
    • 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

    $133.03changed to$132.81

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.40 changed to 3.41

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $132.37changed to$133.03

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $129.86changed to$132.37

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.36 changed to 3.40
    • Malpractice RVU 0.11 changed to 0.12
    • 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

    $127.65changed to$129.86

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.62 changed to 3.36
    • 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: $127.65

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$224.83$76.59RVU26D
2026-07-01$224.83$76.59RVU26C
2026-04-01$224.83$76.59RVU26B
2026-01-01$224.83$76.59RVU26A
2025-10-01$220.99$83.86RVU25D
2025-07-01$220.99$83.86RVU25C
2025-04-01$220.99$83.86RVU25B
2025-01-01$220.99$83.86RVU25A
2024-10-01$231.78$85.63RVU24D
2024-07-01$231.78$85.63RVU24C
2024-04-01$231.78$85.63RVU24B
2024-03-09$231.78$85.63RVU24AR
2024-01-01$228.00$84.23RVU24A
2023-10-01$241.60$87.88RVU23D
2023-07-01$240.26$87.77RVU23C
2023-04-01$240.26$87.77RVU23B
2023-01-01$240.26$87.77RVU23A
2022-10-01$249.90$88.04RVU22D
2022-07-01$249.90$88.04RVU22C
2022-04-01$249.90$88.04RVU22B
2022-01-01$249.90$88.04RVU22A
2021-10-01$259.00$89.11RVU21D
2021-07-01$259.00$89.11RVU21C
2021-04-01$259.00$89.11RVU21B
2021-01-01$259.00$89.11RVU21A
2020-10-01$255.53$92.19RVU20D
2020-07-01$255.53$92.19RVU20C
2020-04-01$255.53$92.19RVU20B
2020-01-01$255.53$92.19RVU20A
2019-10-01$173.45$74.37RVU19D
2019-07-01$173.45$74.37RVU19C
2019-04-01$173.45$74.37RVU19B
2019-01-01$173.45$74.37RVU19A
2018-10-01$172.53$74.65RVU18D
2018-07-01$172.53$74.65RVU18C
2018-04-01$172.53$74.65RVU18B
2018-01-01$172.53$74.65RVU18AR1
2017-10-01$152.26$69.62RVU17D
2017-07-01$152.26$69.62RVU17C
2017-04-01$152.26$69.62RVU17B
2017-01-01$152.26$69.62RVU17A
2016-10-01$132.81$64.65RVU16D
2016-07-01$132.81$64.65RVU16C
2016-04-01$132.81$64.65RVU16B
2016-01-01$132.81$64.65RVU16A
2015-10-01$133.03$64.89RVU15D
2015-07-01$133.03$64.89RVU15C
2015-04-01$132.37$64.56RVU15B
2015-01-01$132.37$64.56RVU15A
2014-10-01$129.86$64.16RVU14D
2014-07-01$129.86$64.16RVU14C
2014-04-01$129.86$64.16RVU14B
2014-01-01$129.86$64.16RVU14A
2013-10-01$127.65$61.21RVU13D
2013-07-01$127.65$61.21RVU13C
2013-04-01$127.65$61.21RVU13B
2013-01-01$127.65$61.21RVU13AR

Price 20220 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

20220 billing questions

How do I choose between 20220 and 20225?

Use 20220 for a bone site classified as superficial, such as the ilium, sternum, ribs, or spinous process. Use 20225 for a deep bone site; the distinction is not determined only by how far the needle travels.

Does 20220 include an open surgical exposure?

No. This code is for needle or trocar sampling. When the bone is exposed through an incision, consider the applicable open bone-biopsy code, such as 20240 for a superficial site.

Can imaging guidance be billed separately?

The code describes bone sampling, not image guidance itself. Separately report guidance only when a distinct guidance service is performed, documented, and meets the requirements of the applicable guidance code.

How are other procedures in the same session paid?

Under the CMS multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are reduced by 50% when performed in the same session.

Can I append modifier 50 or report an assistant?

Modifier 50 is inappropriate for this code. CMS also restricts assistant-at-surgery payment and does not permit co-surgeon or team-surgery reporting.

What same-day care is included?

The 0-day global period includes same-day preoperative and postoperative care. Document the biopsy target, needle or trocar approach, specimen, and indication.

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 20220PPRRVU2026_Oct_nonQPP.csv, line 1,732 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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