Billing code 20206: Muscle biopsyMedicare rate & RVUs in Alaska
Reports needle sampling of muscle through the skin to investigate suspected myopathy, including inflammatory, metabolic, or inherited muscle disease.
Medicare pays $235.60 for 20206 in the office in Alaska (Alaska*). Which amount applies depends on the service address.
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 9 sections
What 20206 covers
A clinician advances a biopsy needle through the skin into a selected muscle and obtains tissue for diagnostic evaluation. Neurologists, rheumatologists, surgeons, and other qualified clinicians may perform this procedure in an office or facility when a muscle specimen is needed to evaluate suspected inflammatory, metabolic, or inherited myopathy. The report should identify the sampled muscle and document the percutaneous needle approach and clinical reason for obtaining tissue.
Choose this code for needle sampling, rather than an open muscle biopsy code, based on the method actually performed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Medicare does not pay an assistant at surgery for this service; 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.
20206 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | $235.60 | $66.63 |
How the 20206 rate is calculated
Each of 20206’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 · 20206
RVUs × geographic indexes × conversion factor
Work0.97
0.97 RVUs× 1.000 GPCI
Practice expense5.20
5.20 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
6.2800
Conversion factor
$33.4009
Medicare rate
$209.76
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20206
The CMS indicators that decide how 20206 is paid alongside other services.
CMS payment indicators · 20206
Muscle biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
20206 without 51 · national office
$209.76
Muscle biopsy
20206-51 · Second procedure: 50%
$104.88
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%).
20206 compared with similar codes
Compare codes · National
20206 vs 20200 vs 20205: Medicare rates
How to choose
- 20200Muscle biopsy
- Choose 20206 when muscle tissue is obtained through the skin with a needle. Choose 20200 for an open biopsy of superficial muscle.
- 20205Muscle biopsy
- 20205 describes a deep muscle biopsy performed by a different approach; 20206 identifies percutaneous needle sampling. The documented technique determines the choice.
20206 billing questions
How does 20206 differ from 20200?
20206 is for muscle tissue obtained with a percutaneous needle. 20200 is used when the muscle biopsy is performed by an open approach.
When would 20205 be selected instead?
Use 20205 for a deep muscle biopsy performed by an approach described by that code, rather than a percutaneous needle biopsy. Document the approach and target muscle.
Can modifier 50 be used for biopsies on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.
Is same-day evaluation and aftercare included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
How does Medicare treat other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard multiple-procedure reduction. An assistant at surgery is not paid; co-surgeons and team surgery are not permitted.
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
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