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Billing code 20251: Vertebral biopsyMedicare rate & RVUs

Reports open tissue sampling from a cervical or lumbar vertebral body, commonly to investigate a suspected bone lesion or vertebral infection.

CMS RVU26DEffective Oct 1, 2026109 payment localities270 Medicare services in 2024

Medicare pays $421.19 for 20251 nationally in a facility.

Medicare rate · 20251

Vertebral biopsy

Work RVUs
5.58
Total RVUs
12.61
Global days
010

National rate · 2026

$421.19

Facility setting, before claim adjustments.

See every locality for 20251 →Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 20251 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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

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

109 of 109 payment localities

20251 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$374.70
Alaska*Unavailable$501.14
ArizonaUnavailable$407.64
ArkansasUnavailable$369.00
AtlantaUnavailable$435.76
AustinUnavailable$425.64
BakersfieldUnavailable$420.27
Baltimore/Surr. CntysUnavailable$450.40
BeaumontUnavailable$401.11
BrazoriaUnavailable$408.86

20251 rates by state

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

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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.

View every state and territory as a table
20251 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are 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)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 20251

Vertebral biopsy

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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

20251 without 51 · national facility

$421.19

Vertebral biopsy

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%).

When to use modifier 51

20251 compared with similar codes

Compare codes · National

4 codes, side by side

  • 20251

    Vertebral biopsy5.58 wRVU

    Not priced

  • 20250

    Vertebral biopsy5.06 wRVU

    Not priced

  • 20225

    Bone biopsy2.39 wRVU

    $364.74

  • 20245

    Bone biopsy5.85 wRVU

    Not priced

How to choose

20250Vertebral biopsy
Both describe open vertebral body sampling, but 20250 is for the thoracic region; 20251 is for the cervical or lumbar region.
20225Bone biopsy
20225 describes deep bone sampling by trocar or needle. Choose 20251 when the vertebral body is sampled through an open surgical approach.
20245Bone biopsy
20245 is for open biopsy of deep bone outside the specific vertebral-body service represented by 20251.

Codes related to 20251

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

Codes related to 20251
CodeHow it relatesNational office range
Same family
20250Vertebral biopsyOpen vertebral body biopsy for the thoracic region.No office rate
Used instead
20225Bone biopsyDeep bone biopsy by trocar or needle rather than open exposure.$321.58–$491.58
20245Bone biopsyOpen deep bone biopsy for a site other than the vertebral body.No office rate

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

Show the CMS file lines behind this rate
RVUs for 20251PPRRVU2026_Oct_nonQPP.csv, line 1,740 (RVU26D)

Open CMS sourceHow we calculate rates

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