$233.90
Choose 20206 when muscle tissue is obtained through the skin with a needle. Choose 20200 for an open biopsy of superficial muscle.
On this page
CMS RVU26D · Effective 2026-10-01
20206 Muscle biopsy Medicare reimbursement rates in Vermont
Reports needle sampling of muscle through the skin to investigate suspected myopathy, including inflammatory, metabolic, or inherited muscle disease. Compare 20206 office and facility rates across CMS payment localities in Vermont.
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 20206 in Vermont?
Vermont 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
$206.21
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$49.14
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Musculoskeletal procedure
About 20206: Percutaneous needle muscle biopsy
Reports needle sampling of muscle through the skin to investigate suspected myopathy, including inflammatory, metabolic, or inherited muscle disease.
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.
CMS billing rules for 20206
- 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 RVU0.97 · 15%
- Practice expense (office) RVU5.20 · 83%
- Malpractice RVU0.11 · 2%
16.8K
Medicare services in 2024 · #1212 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.
20206 compared with similar codes
Office rates for Vermont, from the same CMS release.
$325.56
20205 describes a deep muscle biopsy performed by a different approach; 20206 identifies percutaneous needle sampling. The documented technique determines the choice.
Compare 20206 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
Vermont →
Office / nonfacility
$206.21
Facility
$49.14
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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 20206 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
1,729
- Code
- 20206
- Physician work
- 0.97
- Practice expense
- 5.20
- Malpractice
- 0.11
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.97 | × 1.000 | 0.9700 |
| Practice expense | 5.20 | × 0.990 | 5.1480 |
| Malpractice | 0.11 | × 0.506 | 0.0557 |
| Total RVUs | 6.1737 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$206.21
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.97 | 1 |
| Practice expense | 5.2 | 0.99 |
| Malpractice | 0.11 | 0.506 |
(0.97 × 1 + 5.2 × 0.99 + 0.11 × 0.506) × $33.4009 = $206.21
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.97 | 1 |
| Practice expense | 0.45 | 0.99 |
| Malpractice | 0.11 | 0.506 |
(0.97 × 1 + 0.45 × 0.99 + 0.11 × 0.506) × $33.4009 = $49.14
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.
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 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.
1,7262019F,,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
1,7312021F,,Dilat macular 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
1,73220220,,Bone biopsy trocar/ndl supfc,A,,1.61,4.90,,0.51,,0.17,6.68,2.29,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817