$499.28
Choose 21920 for sampling superficial back or flank soft tissue; 21925 applies when the sampled tissue is deep.
On this page
CMS RVU26D · Effective 2026-10-01
21920 Soft-tissue biopsy Medicare reimbursement rates in Indiana
Reports operative sampling of a superficial soft-tissue abnormality of the back or flank when tissue is obtained for diagnostic examination. Compare 21920 office and facility rates across CMS payment localities in Indiana.
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.
What does Medicare pay for 21920 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$245.21
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$132.50
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Surgical biopsy
About 21920: Superficial back soft-tissue biopsy
Reports operative sampling of a superficial soft-tissue abnormality of the back or flank when tissue is obtained for diagnostic examination.
A surgeon or other qualified proceduralist obtains tissue from a superficial soft-tissue abnormality of the back or flank for diagnosis. The service is used when the procedure samples the abnormality rather than removing it as a therapeutic excision. The documented site and depth distinguish this service from biopsy of a deeper soft-tissue lesion.
Report the biopsy when the operative record supports sampling of superficial tissue and identifies the back or flank site. If the lesion is removed rather than sampled, select the applicable excision code based on the tissue depth and size criteria. This minor procedure has a 10-day global period, which includes related postoperative visits during that period. 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 reduction. Modifier 50 is inappropriate; assistant-at-surgery services are not paid, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 21920
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.06 · 26%
- Practice expense (office) RVU5.54 · 70%
- Malpractice RVU0.30 · 4%
522
Medicare services in 2024 · #3522 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.
21920 compared with similar codes
Office rates for Indiana, from the same CMS release.
$497.28
21930 describes excision of a subcutaneous back or flank lesion smaller than 3 cm. Use 21920 when the service is a biopsy rather than excision.
No office rate
21931 describes excision of a subcutaneous back or flank lesion 3 cm or larger. The distinction from 21920 is excision versus diagnostic sampling, not simply whether tissue is sent for pathology.
Compare 21920 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Indiana →
Office / nonfacility
$245.21
Facility
$132.50
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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 21920 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
2,033
- Code
- 21920
- Physician work
- 2.06
- Practice expense
- 5.54
- Malpractice
- 0.30
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.06 | × 1.000 | 2.0600 |
| Practice expense | 5.54 | × 0.927 | 5.1356 |
| Malpractice | 0.30 | × 0.486 | 0.1458 |
| Total RVUs | 7.3414 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$245.21
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.06 | 1 |
| Practice expense | 5.54 | 0.927 |
| Malpractice | 0.3 | 0.486 |
(2.06 × 1 + 5.54 × 0.927 + 0.3 × 0.486) × $33.4009 = $245.21
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.06 | 1 |
| Practice expense | 1.9 | 0.927 |
| Malpractice | 0.3 | 0.486 |
(2.06 × 1 + 1.9 × 0.927 + 0.3 × 0.486) × $33.4009 = $132.50
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.
21920 billing questions
How does 21920 differ from 21925?
21920 is for a superficial back or flank soft-tissue biopsy. Use 21925 when the sampled soft tissue is deep.
Should 21920 be reported when the entire mass is removed?
No. When the lesion is excised rather than sampled, choose the applicable excision code based on its depth and size.
Are related postoperative visits separately reported during the global period?
Related postoperative visits for 10 days are included in the 10-day global period.
Can modifier 50 be used for biopsies on both sides of the back?
No. The bilateral adjustment does not apply to 21920, and modifier 50 is inappropriate.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and the other procedures are subject to the standard 50% multiple-procedure reduction.
Can an assistant or co-surgeon be billed for this procedure?
Assistant-at-surgery services are not paid for 21920. Co-surgeon and team-surgery billing 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 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.
2,03021820,,Treat sternum fracture,A,,1.33,3.76,,3.44,,0.29,5.38,5.06,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03121825,,Treat sternum fracture,A,,7.57,7.44,NA,7.44,,1.87,16.88,16.88,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03221899,,Unlisted px neck/thorax,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03321920,,Biopsy soft tissue of back,A,,2.06,5.54,,1.90,,0.30,7.90,4.26,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03421925,,Biopsy soft tissue of back,A,,4.51,10.72,,5.62,,1.03,16.26,11.16,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03521930,,Exc back les sc < 3 cm,A,,4.82,10.30,,4.63,,1.07,16.19,10.52,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03621931,,Exc back les sc 3 cm/>,A,,6.71,5.21,NA,5.21,,1.66,13.58,13.58,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915