$315.50–$350.31
Both describe open muscle biopsy. Choose 20200 for superficial muscle and 20205 when the muscle sampled is deep.
On this page
CMS RVU26D · Effective 2026-10-01
20200 Muscle biopsy Medicare reimbursement rates in Texas
Reports an open biopsy of an accessible superficial skeletal muscle when tissue is needed to investigate suspected muscle disease. Compare 20200 office and facility rates across CMS payment localities in Texas.
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 20200 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
$224.56–$251.07
8 of 8 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.
Where 20200 pays more and less in Texas
8 payment localities
$224.56 to $251.07
Surgical procedure
About 20200: Open superficial muscle biopsy
Reports an open biopsy of an accessible superficial skeletal muscle when tissue is needed to investigate suspected muscle disease.
A physician obtains a small sample of accessible skeletal muscle through an open incision for diagnostic examination. Neurologists and surgeons may perform this procedure when evaluation of conditions such as inflammatory myopathy, muscular dystrophy, or metabolic muscle disease requires tissue. The specimen may be sent for histologic or other laboratory studies. This code describes a superficial muscle biopsy, not a needle sample or an open biopsy of a deeper muscle.
Select the code based on the muscle’s depth and the approach documented in the operative report. Documentation should identify the sampled muscle and site, the open approach, and the diagnostic reason for obtaining tissue. The 0-day global period includes same-day preoperative and postoperative care. If 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% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
CMS billing rules for 20200
- 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 RVU1.42 · 20%
- Practice expense (office) RVU5.45 · 75%
- Malpractice RVU0.37 · 5%
505
Medicare services in 2024 · #3553 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.
20200 compared with similar codes
Office rates for Texas, from the same CMS release.
$193.87–$219.48
This code describes a percutaneous needle muscle biopsy; 20200 describes an open biopsy of superficial muscle.
Compare 20200 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office $251.07 | Facility $90.63 |
| Beaumont | Office $224.56 | Facility $86.57 |
| Brazoria | Office $237.84 | Facility $87.57 |
| Dallas | Office $239.77 | Facility $88.73 |
| Fort Worth | Office $238.11 | Facility $88.59 |
| Galveston | Office $238.80 | Facility $88.22 |
| Houston | Office $245.57 | Facility $95.00 |
| Rest Of Texas | Office $231.34 | Facility $87.43 |
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20200 billing questions
How does this differ from 20205?
Use 20200 for an open biopsy of superficial muscle. Code 20205 describes an open biopsy of deep muscle.
When is 20206 more appropriate?
Code 20206 describes a percutaneous needle muscle biopsy. Use 20200 when the documented method is an open biopsy of superficial muscle.
Can modifier 50 be used for biopsies on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
Is same-day postoperative care separately included?
The code has a 0-day global period, which includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon report this procedure?
Medicare does not pay an assistant-at-surgery claim for 20200. Co-surgeons and team surgery are not permitted.
What documentation supports reporting 20200?
The operative report should identify the muscle and site, establish that the biopsy was open and superficial, and state why tissue was obtained.
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.
1,7242016F,,Asthma risk assessed,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
1,7252018F,,Hydration status assess,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
1,7262019F,,Dilated macul exam 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
1,72720200,,Muscle biopsy superficial,A,,1.42,5.45,,0.91,,0.37,7.24,2.70,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,72820205,,Deep muscle biopsy,A,,2.29,7.20,,1.46,,0.65,10.14,4.40,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,72920206,,Biopsy muscle perq needle,A,,0.97,5.20,,0.45,,0.11,6.28,1.53,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7302020F,,Dilated fundus 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