No office rate
Both describe open bone biopsy. Choose 20240 for a superficial site and 20245 for a deep site.
On this page
CMS RVU26D · Effective 2026-10-01
20245 Bone biopsy Medicare reimbursement rates in Pennsylvania
Reports open sampling of a deep bone site to investigate conditions such as suspected infection, a bone lesion, or possible malignancy. Compare 20245 office and facility rates across CMS payment localities in Pennsylvania.
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 20245 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$295.38–$316.55
2 of 2 localities have a supported rate.
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.
Musculoskeletal procedure
About 20245: Open deep bone biopsy
Reports open sampling of a deep bone site to investigate conditions such as suspected infection, a bone lesion, or possible malignancy.
A surgeon obtains bone tissue from a deep site through an open approach, rather than through a percutaneous trocar or needle technique. The specimen may be taken to investigate suspected osteomyelitis, a primary bone tumor, metastatic disease, or another unexplained bone lesion. Orthopedic and orthopedic oncology surgeons commonly perform the procedure in an operating room; it may also be performed in an appropriately equipped office setting.
Select this code when the documented procedure is an open biopsy of a deep bone site. The operative note should identify the bone and site, describe the open approach and sampling, and state the clinical reason for obtaining tissue. Same-day preoperative and postoperative care is included in the 0-day global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay for an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 20245
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU5.85 · 64%
- Practice expense (office) RVU2.18 · 24%
- Malpractice RVU1.05 · 12%
4.7K
Medicare services in 2024 · #1924 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.
20245 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$341.61–$379.18
Both concern deep bone sampling, but 20225 uses a trocar or needle approach; 20245 is open.
No office rate
20250 is specific to open biopsy of a thoracic vertebral body; 20245 is for deep bone sites outside that specific code description.
No office rate
20251 is specific to open biopsy of a lumbar or cervical vertebral body; 20245 describes open biopsy of a deep bone site more generally.
Compare 20245 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$316.55
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$295.38
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20245 billing questions
How does this differ from code 20225?
Code 20245 is for an open approach to a deep bone site. Code 20225 describes deep bone sampling by trocar or needle.
When should 20240 be reported instead?
Use 20240 for an open biopsy of a superficial bone site. The distinction from 20245 is the depth of the site, not simply the bone's name.
Is modifier 50 appropriate for bilateral bone biopsies?
No. CMS identifies bilateral adjustment as inapplicable to this code and modifier 50 as inappropriate.
Does the code include same-day postoperative care?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. 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 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.
1,7342022F,,Dilat rta xm 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
1,7352023F,,Dilat rta xm w/o rtnopthy,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
1,73620240,,Bone biopsy open superficial,A,,2.54,0.95,NA,0.95,,0.30,3.79,3.79,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,73720245,,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