Bone biopsy open deep

CPT code 20245 is used when a surgeon makes an incision through the skin and tissue to obtain a sample of bone from deep within the body for laboratory testing. This is different from a needle biopsy and requires opening the tissue to access the bone directly.

Showing rates for

National Average

Base Medicare rate

$332.52

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

PE RVU (NF)

3.28

MP RVU

Total RVU

10.28

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

NCCI bundling edits

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Billing tips

Ensure operative report clearly documents 'open' approach with incision depth and anatomical layers traversed to justify 20245 versus percutaneous codes (20220-20225)
Impact: Prevents downcoding from $332.52 to approximately $106-$156 for percutaneous biopsy codes, protecting $176-$226 in revenue per case
Document the specific anatomical site of biopsy with precision (e.g., 'left proximal femur' not just 'femur') and whether superficial or deep structures required dissection
Impact: Reduces denial rate by 15-25% by establishing medical necessity and appropriate code selection
When bone biopsy is performed in conjunction with definitive surgical treatment of the same lesion, the biopsy is typically bundled and should not be separately reported
Impact: Prevents improper unbundling that results in 100% denial and potential audit flags
Bill facility (ASC/hospital) and professional components separately when applicable, ensuring place of service codes match the actual location
Impact: Both facility and professional rates are $332.52 for this code; incorrect POS coding can delay payment 30-60 days
For Medicare patients, verify that bone biopsy is not subject to Multiple Procedure Payment Reduction (MPPR) when billed with other procedures on the same date
Impact: While 20245 typically receives full payment, understanding MPPR application prevents unexpected payment reductions on secondary procedures
Obtain and document medical necessity for open approach versus less invasive methods, including prior failed biopsies, lesion characteristics, or anatomical factors

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 20245 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 20245 is $332.52 for both facility and non-facility settings. This is based on a total RVU of 10.28 multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location and Medicare Administrative Contractor (MAC) locality adjustments.

What is the difference between CPT 20245 and 20240?

CPT 20245 describes an open deep bone biopsy requiring incision through multiple tissue layers to access bone in deep anatomical locations. CPT 20240 describes an open superficial bone biopsy where the bone is more easily accessible with minimal dissection. The depth of the bone, complexity of access, and extent of dissection determine which code is appropriate.

Can CPT 20245 be billed with an excision code for the same bone lesion?

Generally, no. When a bone biopsy is performed during the same operative session as definitive excision or treatment of the same lesion, the biopsy is considered included in the more comprehensive procedure and should not be separately reported. However, if the biopsy is of a separate distinct lesion or performed at a staged procedure prior to definitive treatment, separate billing may be appropriate with modifier 59.

What documentation is required to support medical necessity for CPT 20245?

Documentation must include the clinical indication for bone biopsy (imaging findings, suspected diagnosis), justification for the open approach versus less invasive methods, specific anatomical location, pre-operative diagnosis, and the operative report detailing the open surgical technique with tissue layers traversed. Evidence of prior failed percutaneous attempts or contraindications to image-guided biopsy strengthens medical necessity.

How many RVUs is CPT code 20245 worth in 2025?

CPT 20245 has a total RVU value of 10.28 in 2025, consisting of 6.00 work RVUs, 3.28 practice expense RVUs (both facility and non-facility), and 1.00 malpractice RVU. This represents a moderate-complexity surgical procedure requiring significant physician work and resources.

What modifier should be used for bilateral bone biopsies under CPT 20245?

Modifier 50 should be appended to CPT 20245 when bilateral bone biopsies are performed during the same operative session on corresponding anatomical structures (e.g., bilateral iliac crests). This typically results in 150% of the standard reimbursement when bilateral procedures are medically necessary. Alternatively, some payers prefer reporting the code twice with LT and RT modifiers.

Is CPT 20245 subject to the global surgical package?

Yes, CPT 20245 is assigned a 90-day global period under Medicare rules. This means the reimbursement includes pre-operative evaluation (day before or day of surgery), the surgical procedure itself, and routine post-operative care for 90 days following the procedure. Complications requiring return to the OR may be separately billable with appropriate modifiers (78 or 79 depending on relationship to original procedure).