CPT code 20250: Vertebral biopsy, open, thoracic level2026 Medicare rate & RVUs in California

CMS doesn’t publish an office rate for 20250 in California.

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

What 20250 covers

This service involves surgically exposing a thoracic vertebral body and removing tissue for diagnostic evaluation. It is generally performed by a spine surgeon, orthopedic surgeon, or neurosurgeon in a facility setting when a vertebral abnormality requires tissue sampling. The open approach distinguishes it from a biopsy obtained with a trocar or needle; the vertebral level distinguishes it from the corresponding cervical or lumbar procedure.

Select the code when the operative documentation identifies an open biopsy of a thoracic vertebral body. Documentation should establish the vertebral site, open approach, reason for sampling, and tissue obtained. Medicare assigns a 10-day global period, so related postoperative visits during that period are included. For multiple procedures 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 service, 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.

Where 20250 pays more and less in California

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

29 of 29 payment localities

How the 20250 rate is calculated

Each of 20250’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.

Payment rules and modifiers for 20250

20250 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

20250 compared with similar codes

How to choose

20251Vertebral biopsyOpen, cervical or lumbar

Use 20250 for an open thoracic vertebral body biopsy; use 20251 for the corresponding cervical or lumbar region.

20220Bone biopsyTrocar or needle, superficial

20220 describes a superficial-site bone biopsy using a trocar or needle, not open sampling of a thoracic vertebral body.

20225Bone biopsyDeep, needle or trocar

20225 describes a deep-site bone biopsy using a trocar or needle. The open approach and thoracic vertebral site support 20250 instead.

Codes related to 20250

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

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

Open CMS sourceHow we calculate rates