CPT code 20251: Vertebral biopsy, open, cervical or lumbar2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $422.33 for 20251 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 20251 nationwide

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

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.

How Puerto Rico compares for 20251

Across 109 of 109 payment localities, the facility rate for 20251 runs from $369.00 in Arkansas to $514.53 in NYC suburbs and Long Island, NY. Puerto Rico pays $422.33. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

20251 rates by state

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

See 20251 in every payment locality

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.

Payment rules and modifiers for 20251

20251 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

Codes related to 20251

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

How 20251 has changed in Puerto Rico

Price 20251 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

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