No office rate
Both describe open vertebral body sampling, but 20250 is for the thoracic region; 20251 is for the cervical or lumbar region.
On this page
CMS RVU26D · Effective 2026-10-01
20251 in Merced
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$415.85
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Bone biopsy
About 20251: Open cervical or lumbar vertebral biopsy
Reports open tissue sampling from a cervical or lumbar vertebral body, commonly to investigate a suspected bone lesion or vertebral infection.
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.
CMS billing rules for 20251
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.58 · 44%
- Practice expense (office) RVU5.37 · 43%
- Malpractice RVU1.66 · 13%
270
Medicare services in 2024 · #4073 by national volume
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.
20251 compared with similar codes
Office rates for Merced, from the same CMS release.
$388.58
20225 describes deep bone sampling by trocar or needle. Choose 20251 when the vertebral body is sampled through an open surgical approach.
No office rate
20245 is for open biopsy of deep bone outside the specific vertebral-body service represented by 20251.
The same code, a different location
How does Merced compare?
20251 across payment areas
Same release and payment basis · bars start at $0
Merced · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Madera
California · 20251
Office
Unavailable
Facility
$415.85
No comparable office rate is available.
Modesto
California · 20251
Office
Unavailable
Facility
$415.85
No comparable office rate is available.
Napa
California · 20251
Office
Unavailable
Facility
$462.69
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 20251
Office
Unavailable
Facility
$438.14
No comparable office rate is available.
Redding
California · 20251
Office
Unavailable
Facility
$415.85
No comparable office rate is available.
Rest Of California
California · 20251
Office
Unavailable
Facility
$415.85
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 20251
Office
Unavailable
Facility
$433.61
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 20251
Office
Unavailable
Facility
$431.40
No comparable office rate is available.
Salinas
California · 20251
Office
Unavailable
Facility
$429.76
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 20251
Office
Unavailable
Facility
$436.54
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 20251
Office
Unavailable
Facility
$482.43
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 20251
Office
Unavailable
Facility
$480.55
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 20251
Office
Unavailable
Facility
$495.24
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 20251
Office
Unavailable
Facility
$487.53
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 20251
Office
Unavailable
Facility
$423.56
No comparable office rate is available.
Santa Cruz-Watsonville
California · 20251
Office
Unavailable
Facility
$437.94
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 20251
Office
Unavailable
Facility
$430.45
No comparable office rate is available.
Santa Rosa-Petaluma
California · 20251
Office
Unavailable
Facility
$441.94
No comparable office rate is available.
Stockton
California · 20251
Office
Unavailable
Facility
$415.85
No comparable office rate is available.
Vallejo
California · 20251
Office
Unavailable
Facility
$459.97
No comparable office rate is available.
Visalia
California · 20251
Office
Unavailable
Facility
$415.85
No comparable office rate is available.
Yuba City
California · 20251
Office
Unavailable
Facility
$415.85
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 20251
Office
Unavailable
Facility
$469.44
No comparable office rate is available.
Miami
Florida · 20251
Office
Unavailable
Facility
$513.32
No comparable office rate is available.
Chicago
Illinois · 20251
Office
Unavailable
Facility
$495.19
No comparable office rate is available.
Manhattan
New York · 20251
Office
Unavailable
Facility
$494.66
No comparable office rate is available.
Alaska*
Alaska · 20251
Office
Unavailable
Facility
$501.14
No comparable office rate is available.
Alabama
Alabama · 20251
Office
Unavailable
Facility
$374.70
No comparable office rate is available.
Arkansas
Arkansas · 20251
Office
Unavailable
Facility
$369.00
No comparable office rate is available.
Arizona
Arizona · 20251
Office
Unavailable
Facility
$407.64
No comparable office rate is available.
Colorado
Colorado · 20251
Office
Unavailable
Facility
$422.76
No comparable office rate is available.
Connecticut
Connecticut · 20251
Office
Unavailable
Facility
$450.37
No comparable office rate is available.
Delaware
Delaware · 20251
Office
Unavailable
Facility
$414.36
No comparable office rate is available.
Fort Lauderdale
Florida · 20251
Office
Unavailable
Facility
$468.32
No comparable office rate is available.
Rest Of Florida
Florida · 20251
Office
Unavailable
Facility
$441.18
No comparable office rate is available.
Atlanta
Georgia · 20251
Office
Unavailable
Facility
$435.76
No comparable office rate is available.
Rest Of Georgia
Georgia · 20251
Office
Unavailable
Facility
$412.46
No comparable office rate is available.
Hawaii, Guam
Hawaii · 20251
Office
Unavailable
Facility
$422.42
No comparable office rate is available.
Iowa
Iowa · 20251
Office
Unavailable
Facility
$372.51
No comparable office rate is available.
Idaho
Idaho · 20251
Office
Unavailable
Facility
$377.62
No comparable office rate is available.
East St. Louis
Illinois · 20251
Office
Unavailable
Facility
$463.06
No comparable office rate is available.
Rest Of Illinois
Illinois · 20251
Office
Unavailable
Facility
$436.80
No comparable office rate is available.
Suburban Chicago
Illinois · 20251
Office
Unavailable
Facility
$470.14
No comparable office rate is available.
Indiana
Indiana · 20251
Office
Unavailable
Facility
$379.59
No comparable office rate is available.
Kansas
Kansas · 20251
Office
Unavailable
Facility
$376.47
No comparable office rate is available.
Kentucky
Kentucky · 20251
Office
Unavailable
Facility
$396.56
No comparable office rate is available.
New Orleans
Louisiana · 20251
Office
Unavailable
Facility
$418.14
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 20251
Office
Unavailable
Facility
$398.23
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 20251
Office
Unavailable
Facility
$457.52
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 20251
Office
Unavailable
Facility
$422.42
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 20251
Office
Unavailable
Facility
$450.40
No comparable office rate is available.
Rest Of Maryland
Maryland · 20251
Office
Unavailable
Facility
$420.65
No comparable office rate is available.
Rest Of Maine
Maine · 20251
Office
Unavailable
Facility
$385.88
No comparable office rate is available.
Southern Maine
Maine · 20251
Office
Unavailable
Facility
$399.11
No comparable office rate is available.
Detroit
Michigan · 20251
Office
Unavailable
Facility
$452.94
No comparable office rate is available.
Rest Of Michigan
Michigan · 20251
Office
Unavailable
Facility
$412.73
No comparable office rate is available.
Minnesota
Minnesota · 20251
Office
Unavailable
Facility
$387.35
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 20251
Office
Unavailable
Facility
$408.97
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 20251
Office
Unavailable
Facility
$412.69
No comparable office rate is available.
Rest Of Missouri
Missouri · 20251
Office
Unavailable
Facility
$394.99
No comparable office rate is available.
Mississippi
Mississippi · 20251
Office
Unavailable
Facility
$381.78
No comparable office rate is available.
Montana**
Montana · 20251
Office
Unavailable
Facility
$421.07
No comparable office rate is available.
North Carolina
North Carolina · 20251
Office
Unavailable
Facility
$389.15
No comparable office rate is available.
North Dakota**
North Dakota · 20251
Office
Unavailable
Facility
$388.25
No comparable office rate is available.
Nebraska
Nebraska · 20251
Office
Unavailable
Facility
$372.89
No comparable office rate is available.
New Hampshire
New Hampshire · 20251
Office
Unavailable
Facility
$421.61
No comparable office rate is available.
Northern Nj
New Jersey · 20251
Office
Unavailable
Facility
$465.40
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 20251
Office
Unavailable
Facility
$450.52
No comparable office rate is available.
New Mexico
New Mexico · 20251
Office
Unavailable
Facility
$417.44
No comparable office rate is available.
Nevada**
Nevada · 20251
Office
Unavailable
Facility
$412.11
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 20251
Office
Unavailable
Facility
$514.53
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 20251
Office
Unavailable
Facility
$458.26
No comparable office rate is available.
Queens
New York · 20251
Office
Unavailable
Facility
$490.26
No comparable office rate is available.
Rest Of New York
New York · 20251
Office
Unavailable
Facility
$395.75
No comparable office rate is available.
Ohio
Ohio · 20251
Office
Unavailable
Facility
$406.02
No comparable office rate is available.
Oklahoma
Oklahoma · 20251
Office
Unavailable
Facility
$389.63
No comparable office rate is available.
Portland
Oregon · 20251
Office
Unavailable
Facility
$429.88
No comparable office rate is available.
Rest Of Oregon
Oregon · 20251
Office
Unavailable
Facility
$404.00
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 20251
Office
Unavailable
Facility
$442.59
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 20251
Office
Unavailable
Facility
$403.43
No comparable office rate is available.
Puerto Rico
Puerto Rico · 20251
Office
Unavailable
Facility
$422.33
No comparable office rate is available.
Rhode Island
Rhode Island · 20251
Office
Unavailable
Facility
$424.66
No comparable office rate is available.
South Carolina
South Carolina · 20251
Office
Unavailable
Facility
$399.24
No comparable office rate is available.
South Dakota**
South Dakota · 20251
Office
Unavailable
Facility
$384.37
No comparable office rate is available.
Tennessee
Tennessee · 20251
Office
Unavailable
Facility
$379.19
No comparable office rate is available.
Austin
Texas · 20251
Office
Unavailable
Facility
$425.64
No comparable office rate is available.
Beaumont
Texas · 20251
Office
Unavailable
Facility
$401.11
No comparable office rate is available.
Brazoria
Texas · 20251
Office
Unavailable
Facility
$408.86
No comparable office rate is available.
Dallas
Texas · 20251
Office
Unavailable
Facility
$414.27
No comparable office rate is available.
Fort Worth
Texas · 20251
Office
Unavailable
Facility
$413.20
No comparable office rate is available.
Galveston
Texas · 20251
Office
Unavailable
Facility
$411.88
No comparable office rate is available.
Houston
Texas · 20251
Office
Unavailable
Facility
$442.27
No comparable office rate is available.
Rest Of Texas
Texas · 20251
Office
Unavailable
Facility
$406.66
No comparable office rate is available.
Utah
Utah · 20251
Office
Unavailable
Facility
$404.77
No comparable office rate is available.
Virginia
Virginia · 20251
Office
Unavailable
Facility
$401.84
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 20251
Office
Unavailable
Facility
$422.33
No comparable office rate is available.
Vermont
Vermont · 20251
Office
Unavailable
Facility
$392.00
No comparable office rate is available.
Rest Of Washington
Washington · 20251
Office
Unavailable
Facility
$419.86
No comparable office rate is available.
Seattle (King Cnty)
Washington · 20251
Office
Unavailable
Facility
$461.07
No comparable office rate is available.
Wisconsin
Wisconsin · 20251
Office
Unavailable
Facility
$375.28
No comparable office rate is available.
West Virginia
West Virginia · 20251
Office
Unavailable
Facility
$421.59
No comparable office rate is available.
Wyoming**
Wyoming · 20251
Office
Unavailable
Facility
$406.77
No comparable office rate is available.
See how rates vary across the country
20251 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Merced is a Medicare payment area. Our Census mapping connects it to 24 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 20251 in Merced. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$457.44
$415.85 × 110% = $457.44
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 20251 in Merced.
PPRRVU2026_Oct_nonQPP.csv
1,740
- Code
- 20251
- Physician work
- 5.58
- Practice expense
- 5.37
- Malpractice
- 1.66
GPCI2026.csv
15
- Locality
- Merced
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.58 | × 1.017 | 5.6749 |
| Practice expense | 5.37 | × 1.096 | 5.8855 |
| Malpractice | 1.66 | × 0.536 | 0.8898 |
| Total RVUs | 12.4501 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Merced$415.85
Open 20251 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.58 | 1.017 |
| Practice expense | 5.37 | 1.096 |
| Malpractice | 1.66 | 0.536 |
(5.58 × 1.017 + 5.37 × 1.096 + 1.66 × 0.536) × $33.4009 = $415.85
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
20251 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $415.85 | RVU26D |
| 2026-07-01 | Not available in this setting | $415.85 | RVU26C |
| 2026-04-01 | Not available in this setting | $415.85 | RVU26B |
| 2026-01-01 | Not available in this setting | $415.85 | RVU26A |
| 2025-10-01 | Not available in this setting | $421.15 | RVU25D |
| 2025-07-01 | Not available in this setting | $421.15 | RVU25C |
| 2025-04-01 | Not available in this setting | $421.15 | RVU25B |
| 2025-01-01 | Not available in this setting | $421.15 | RVU25A |
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,73720245,,Bone biopsy open deep,A,,5.85,2.18,NA,2.18,,1.05,9.08,9.08,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7382024F,,7 fld rta photo evc rtnopthy,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,73920250,,Biopsy vrt bdy open thoracic,A,,5.06,5.08,NA,5.08,,1.46,11.60,11.60,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,74020251,,Biopsy vrt bdy open lmbr/crv,A,,5.58,5.37,NA,5.37,,1.66,12.61,12.61,0,010,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7412025F,,7 fld rta photo w/o rtnopthy,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7422026F,,Eye img valid evc rtnopthy,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7432027F,,Optic nerve head eval done,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1201112,CA,57,HANFORD-CORCORAN,1.017,1.096,0.536
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623