Billing code 20205: Muscle biopsyMedicare rate & RVUs in Georgia
Reports open sampling of deep muscle tissue for diagnostic evaluation when a superficial sample or percutaneous needle approach is not the method performed.
Medicare pays $316.88–$347.13 for 20205 in the office in Georgia, from Rest Of Georgia to Atlanta. 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 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 in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | $347.13 | $152.34 |
| Rest Of Georgia | $316.88 | $145.87 |
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.
How the rate is built · 20205
RVUs × geographic indexes × conversion factor
Work2.29
2.29 RVUs× 1.000 GPCI
Practice expense7.20
7.20 RVUs× 1.000 GPCI
Malpractice0.65
0.65 RVUs× 1.000 GPCI
Adjusted RVUs
10.1400
Conversion factor
$33.4009
Medicare rate
$338.69
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20205
The CMS indicators that decide how 20205 is paid alongside other services.
CMS payment indicators · 20205
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
20205 without 51 · national office
$338.69
Muscle biopsy
20205-51 · Second procedure: 50%
$169.35
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%).
20205 compared with similar codes
Compare codes · National
4 codes, side by side
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.
20205 billing questions
How is this distinguished from a superficial muscle biopsy?
Use 20205 when the open approach reaches deep muscle tissue. A superficial muscle sample is reported with 20200.
How does this differ from a percutaneous muscle biopsy?
This code describes an open approach to deep muscle. Use 20206 when the muscle is sampled percutaneously with a needle.
Is the pathology examination included?
The code reports obtaining the muscle specimen. A pathologist may separately report the tissue examination, such as 88305, when that service is performed and documented.
Can modifier 50 be used for biopsies on both sides?
Modifier 50 is inappropriate for this descriptor and anatomy, so do not report a bilateral adjustment.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 20205. Co-surgeon and team-surgery reporting are not permitted.
What same-session payment reduction should the billing team expect?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure payment.
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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