Billing code 20205: Muscle biopsyMedicare rate & RVUs

Medicare pays $338.69 for 20205 nationally in the office and $146.96 in a hospital or facility. Local office rates run $294.25–$443.32.

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

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.

Where 20205 pays more and less

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

109 of 109 payment localities

20205 rates by state

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

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.

Payment rules and modifiers for 20205

The CMS indicators that decide how 20205 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

20205 compared with similar codes

How to choose

20200Muscle biopsy

Choose 20200 for an open sample of superficial muscle; 20205 is for an open approach that reaches deep muscle tissue.

20206Muscle biopsy

Choose 20206 when muscle is sampled percutaneously with a needle. The open deep-muscle approach is reported with 20205.

20245Bone biopsy

20245 is an open biopsy of deep bone, not muscle. Select the code based on the tissue sampled.

Codes related to 20205

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