No office rate
Both describe open vertebral body sampling, but 20250 is for the thoracic region; 20251 is for the cervical or lumbar region.
On this page
CMS RVU26D · Effective 2026-10-01
20251 Vertebral biopsy Medicare reimbursement rates in Wyoming
Reports open tissue sampling from a cervical or lumbar vertebral body, commonly to investigate a suspected bone lesion or vertebral infection. Compare 20251 office and facility rates across CMS payment localities in Wyoming.
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 20251 in Wyoming?
Wyoming 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
No supported rate
Facility setting
$406.77
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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.
Bone biopsy
About 20251: Open cervical or lumbar vertebral biopsy
Reports open tissue sampling from a cervical or lumbar vertebral body, commonly to investigate a suspected bone lesion or vertebral infection.
This service involves surgically exposing a cervical or lumbar vertebral body and obtaining tissue for diagnostic evaluation, such as when imaging raises concern for a tumor or infection. A neurosurgeon or orthopedic spine surgeon typically performs it in an operating room. The code is specific to the vertebral body and an open approach; a needle or trocar sample through the skin is a different service.
Select the code when the operative report supports open sampling of a cervical or lumbar vertebral body. Document the spinal region and level, the open approach, and the tissue obtained. Related postoperative visits during the 10-day global period are included. When other procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate. Medicare may pay for an assistant at surgery, but co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 20251
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.58 · 44%
- Practice expense (office) RVU5.37 · 43%
- Malpractice RVU1.66 · 13%
270
Medicare services in 2024 · #4073 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.
20251 compared with similar codes
Office rates for Wyoming, from the same CMS release.
$362.48
20225 describes deep bone sampling by trocar or needle. Choose 20251 when the vertebral body is sampled through an open surgical approach.
No office rate
20245 is for open biopsy of deep bone outside the specific vertebral-body service represented by 20251.
Compare 20251 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
Wyoming** →
Office / nonfacility
Unavailable
Facility
$406.77
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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 20251 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
1,740
- Code
- 20251
- Physician work
- 5.58
- Practice expense
- 5.37
- Malpractice
- 1.66
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.58 | × 1.000 | 5.5800 |
| Practice expense | 5.37 | × 1.000 | 5.3700 |
| Malpractice | 1.66 | × 0.740 | 1.2284 |
| Total RVUs | 12.1784 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$406.77
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.58 | 1 |
| Practice expense | 5.37 | 1 |
| Malpractice | 1.66 | 0.74 |
(5.58 × 1 + 5.37 × 1 + 1.66 × 0.74) × $33.4009 = $406.77
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.
20251 billing questions
How do I distinguish this from 20250?
Use 20251 for an open biopsy of a cervical or lumbar vertebral body. Code 20250 is for an open thoracic vertebral body biopsy.
Is a needle biopsy reported with this code?
No. A percutaneous trocar or needle approach is distinct from open surgical exposure; consider 20225 when its deep bone biopsy criteria are met.
What documentation supports the open approach?
The operative report should describe surgical exposure of the vertebral body, the cervical or lumbar region and level, and the tissue sampled.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the others at 50%. Related postoperative visits for 10 days are included in this code's global period.
Can an assistant or co-surgeon be billed?
Assistant-at-surgery payment may be made. Co-surgeons and team surgery are not permitted for this code.
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.
1,73720245,,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
1,7412025F,,7 fld rta photo w/o 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
1,7422026F,,Eye img valid 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
1,7432027F,,Optic nerve head 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
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,