CPT code 20251: Vertebral biopsy, open, cervical or lumbar2026 Medicare rate & RVUs in Missouri
Reports open tissue sampling from a cervical or lumbar vertebral body, commonly to investigate a suspected bone lesion or vertebral infection.
CMS doesn’t publish an office rate for 20251 in Missouri.
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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What 20251 covers
This service involves surgically exposing a cervical or lumbar vertebral body and obtaining tissue for diagnostic evaluation, such as when imaging raises concern for a tumor or infection. A neurosurgeon or orthopedic spine surgeon typically performs it in an operating room. The code is specific to the vertebral body and an open approach; a needle or trocar sample through the skin is a different service.
Select the code when the operative report supports open sampling of a cervical or lumbar vertebral body. Document the spinal region and level, the open approach, and the tissue obtained. Related postoperative visits during the 10-day global period are included. When other procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate. Medicare may pay for an assistant at surgery, but co-surgeon and team-surgery billing 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 20251 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $408.97 |
| Metropolitan St. Louis, MO | Unavailable | $412.69 |
| Rest of Missouri | Unavailable | $394.99 |
How the 20251 rate is calculated
Each of 20251’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 · 20251
RVUs × geographic indexes × conversion factor
Work5.58
5.58 RVUs× 1.000 GPCI
Practice expense5.37
5.37 RVUs× 1.000 GPCI
Malpractice1.66
1.66 RVUs× 1.000 GPCI
Adjusted RVUs
12.6100
Conversion factor
$33.4009
Medicare rate
$421.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20251
20251 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20251
Vertebral biopsy, open, cervical or lumbar
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 20251
Vertebral biopsy, open, cervical or lumbar
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
20251 without 51 · national facility
$421.19
Vertebral biopsy, open, cervical or lumbar
20251-51 · Second procedure: 50%
$210.60
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%).
20251 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 20250Vertebral biopsyOpen, thoracic level
- Both describe open vertebral body sampling, but 20250 is for the thoracic region; 20251 is for the cervical or lumbar region.
- 20225Bone biopsyDeep, needle or trocar
- 20225 describes deep bone sampling by trocar or needle. Choose 20251 when the vertebral body is sampled through an open surgical approach.
- 20245Bone biopsyOpen approach, deep site
- 20245 is for open biopsy of deep bone outside the specific vertebral-body service represented by 20251.
20251 billing questions
How do I distinguish this from 20250?
Use 20251 for an open biopsy of a cervical or lumbar vertebral body. Code 20250 is for an open thoracic vertebral body biopsy.
Is a needle biopsy reported with this code?
No. A percutaneous trocar or needle approach is distinct from open surgical exposure; consider 20225 when its deep bone biopsy criteria are met.
What documentation supports the open approach?
The operative report should describe surgical exposure of the vertebral body, the cervical or lumbar region and level, and the tissue sampled.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the others at 50%. Related postoperative visits for 10 days are included in this code's global period.
Can an assistant or co-surgeon be billed?
Assistant-at-surgery payment may be made. Co-surgeons and team surgery are not permitted for this code.
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
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