Bone biopsy open superficial

CPT code 20240 is used when a surgeon makes a small incision in the skin to remove a piece of bone tissue from near the surface for laboratory testing. This is different from a needle biopsy because it requires an open surgical cut to access the bone.

Showing rates for

National Average

Base Medicare rate

$135.86

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.61

PE RVU (NF)

1.3

MP RVU

0.29

Total RVU

4.2

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Clearly document 'open' approach with incision size and depth to differentiate from needle biopsy codes (20220, 20225) which reimburse lower
Impact: Prevents downcoding to CPT 20220 at $98.48, protecting $37.38 per claim
Specify anatomical location precisely in operative note; code 20240 is for superficial bones only - deep bone biopsies use 20245
Impact: Ensures correct code selection as 20245 has different facility payment structure
Bill separately for pathology interpretation (88305 or 88307) as this is not included in the surgical code
Impact: Captures additional revenue for specimen analysis; 88305 adds approximately $75-100 depending on payer
Document medical necessity clearly when performed same day as imaging; link to specific radiological findings
Impact: Reduces denial rate for same-day diagnostic work-up by establishing distinct services
For bilateral procedures, verify payer policy on modifier 50 vs. separate line items with LT/RT modifiers
Impact: Some Medicare MACs prefer RT/LT with 50% reduction on second line; incorrect billing delays payment 15-30 days
Confirm global period is 10 days; avoid billing related E/M services during this window without appropriate modifiers
Impact: Prevents automatic denials of post-op visits; unmodified E/M during global results in 100% denial

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 20240 in 2025?

The 2025 Medicare national average payment for CPT 20240 is $135.86 for both facility and non-facility settings, based on 4.2 total RVUs and the conversion factor of 32.3465.

What is the difference between CPT 20240 and 20220?

CPT 20240 is for open bone biopsy requiring surgical incision, while 20220 is for needle bone biopsy performed percutaneously. The open approach (20240) requires cutting through skin and tissue layers to directly visualize and sample bone, whereas needle biopsy uses a trocar or needle without open incision.

Can CPT 20240 be billed bilaterally?

Yes, CPT 20240 can be billed bilaterally when bone biopsies are performed on both sides of the body at mirror-image superficial locations. Use modifier 50 for bilateral procedure or submit two line items with RT and LT modifiers depending on payer preference.

What modifiers are commonly used with CPT 20240?

Common modifiers for 20240 include LT/RT for laterality, modifier 59 for distinct procedural service at separate site, modifier 25 for separately identifiable E/M service same day, and modifier 50 for bilateral procedures.

How many RVUs is CPT code 20240 worth in 2025?

CPT 20240 has 4.2 total RVUs in 2025, comprised of 2.61 work RVUs, 1.3 practice expense RVUs (both facility and non-facility), and 0.29 malpractice RVUs.

What documentation is required to bill CPT 20240?

Required documentation includes medical necessity/indication, specific anatomical location, description of open surgical approach with incision details, confirmation of bone tissue obtained, closure technique, specimen disposition, and any complications. The operative note must clearly differentiate this from a percutaneous needle approach.

Is CPT 20240 subject to a global surgery period?

Yes, CPT 20240 has a 10-day global surgery period. Post-operative visits within these 10 days are included in the surgical payment unless a separately identifiable service is provided and documented with appropriate modifiers such as 24 or 25.