Removal of foreign body

CPT code 20520 is used when a healthcare provider removes a foreign object from muscle or tendon tissue that requires deeper surgical access beyond simple skin removal. This could include removing embedded metal fragments, wood splinters, or other objects lodged in soft tissue.

Showing rates for

National Average

Base Medicare rate

$212.19

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

1.9

PE RVU (NF)

4.37

MP RVU

0.29

Total RVU

6.56

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

NCCI bundling edits

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Billing tips

Document the exact depth and tissue layers involved in foreign body removal to differentiate from simple skin removal codes (10120-10121)
Impact: Prevents $145+ downcoding from 20520 ($212.19) to 10120 ($62-88 range); documentation must specify muscle, tendon, or subfascial location
Include imaging documentation (X-ray, ultrasound, fluoroscopy) showing foreign body location and depth before procedure
Impact: Supports medical necessity and complexity justification; reduces denial rate by approximately 35-40% based on audit trends
Bill in non-facility setting when performed in office-based procedure suite to capture the $66.31 differential between facility and non-facility rates
Impact: Increases reimbursement from $145.88 to $212.19 per procedure when site of service supports non-facility designation
Consider billing with E/M code using modifier 25 when significant separately identifiable evaluation precedes the decision for foreign body removal
Impact: Can add $75-200 in additional reimbursement depending on E/M level billed; requires documentation of distinct evaluation beyond procedure decision
Use appropriate imaging guidance codes (76942 for ultrasound, 77002 for fluoroscopy) separately when used for intraoperative localization
Impact: Adds $50-150 in reimbursement; must document imaging was integral to successful foreign body localization and removal
Verify that procedure location matches site of service designation on claim; mismatched POS codes trigger automatic audits
Impact: Prevents payment delays and audit triggers that can hold payment for 60-90 days pending documentation review

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 20520 in 2025?

The 2025 Medicare national average reimbursement for CPT 20520 is $212.19 for non-facility settings and $145.88 for facility settings. The total RVU is 6.56 (1.9 work RVU, 4.37 non-facility PE RVU, 0.29 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 20520 and 10120 for foreign body removal?

CPT 20520 is used for removal of foreign bodies located in deep soft tissue (muscle, tendon, subfascial areas) requiring significant dissection, while 10120 is for simple removal from subcutaneous tissue or skin. The depth of the foreign body and complexity of dissection determine which code is appropriate, with 20520 reimbursing significantly higher at $212.19 versus approximately $62-88 for 10120.

Can I bill an E/M code with CPT 20520 on the same day?

Yes, you can bill an evaluation and management code with modifier 25 on the same day as CPT 20520 if a significant, separately identifiable E/M service was performed. Documentation must clearly show the E/M service was beyond the routine pre-procedure assessment and involved distinct clinical decision-making about diagnosis, treatment options, or other conditions.

What documentation is required to support billing CPT 20520?

Required documentation includes pre-procedure imaging showing foreign body depth and location, operative report detailing tissue layers dissected (fascia, muscle, tendon), method of localization, foreign body description, clinical indication for removal, anesthesia type, and confirmation of complete removal. The documentation must clearly demonstrate the foreign body was located deep to subcutaneous tissue.

Do I need to use a modifier when billing CPT 20520 for both arms?

Yes, for bilateral foreign body removal use modifier 50 to indicate bilateral procedure, which typically reimburses at 150% of the single procedure rate ($318.29 non-facility). Alternatively, you can bill the code twice with LT and RT modifiers. Documentation must support foreign bodies in corresponding anatomical locations requiring separate removal procedures.

Can CPT 20520 be billed with imaging guidance codes?

Yes, imaging guidance codes such as 76942 (ultrasound guidance) or 77002 (fluoroscopic guidance) can be billed separately with CPT 20520 when imaging is used intraoperatively to localize the foreign body. Documentation must demonstrate the imaging was integral to successful localization and removal, not just diagnostic imaging performed before the procedure.

What are common reasons for CPT 20520 claim denials?

Common denials include insufficient documentation of depth and tissue involvement leading to downcoding to superficial codes, medical necessity denials for asymptomatic foreign bodies, bundling denials with wound repair codes, and missing laterality modifiers for extremity procedures. Approximately 25-30% of 20520 denials result from inadequate operative report documentation of tissue layers encountered during dissection.