CPT 24065Surgery

Biopsy arm/elbow soft tissue

CPT code 24065 covers taking a tissue sample (biopsy) from the soft tissue of the arm or elbow area to test for abnormalities, masses, or disease. This is a surgical procedure performed when imaging or physical exam reveals a concerning lump or lesion.

Showing rates for

National Average

Base Medicare rate

$250.69

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

2.13

PE RVU (NF)

5.33

MP RVU

0.29

Total RVU

7.75

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

NCCI bundling edits

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Billing tips

Verify setting of service carefully: bill in correct facility vs non-facility setting as this affects payment by $90.90
Impact: Non-facility rate $250.69 vs facility rate $159.79 represents 57% higher reimbursement; incorrect place of service code will trigger recoupment
Document depth and approach explicitly: operative note must clearly state 'deep soft tissue biopsy' to distinguish from simple/superficial biopsies (20206)
Impact: Downcoding from 24065 to 20206 results in approximately $150+ loss in reimbursement; depth documentation is the most common audit trigger
Do not bundle imaging guidance separately if used: ultrasound or fluoroscopic guidance during biopsy is typically included in 24065
Impact: Attempting to bill 76942 or 77002 separately will result in denial due to NCCI bundling; save approximately 15 minutes of appeal time per claim
Bill separately for complex closure if performed: if biopsy requires layered closure beyond simple repair, consider adding appropriate repair code with modifier 59
Impact: May add $100-300 to reimbursement when intermediate or complex closure codes (12031-13133) are appropriately documented and medically necessary
Confirm pathology report is filed before claim submission: link pathology findings in documentation to support medical necessity
Impact: Pre-submission pathology correlation reduces denial rate by approximately 30% and speeds payment by 10-14 days on average
Use diagnosis codes that support medical necessity: ICD-10 codes for mass/lump (M79.89), neoplasm of uncertain behavior (D48.1), or specific tumor codes justify procedure better than pain codes alone

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 24065 in 2025?

The 2025 Medicare national average reimbursement for CPT 24065 is $250.69 in the non-facility (office) setting and $159.79 in the facility (hospital/ASC) setting. Actual payment may vary by geographic location based on local GPCI adjustments.

What is the difference between CPT 24065 and 20206?

CPT 24065 is for deep soft tissue biopsy of the arm or elbow, requiring dissection through subcutaneous tissue and fascia to access deeper structures. CPT 20206 is for superficial soft tissue biopsy involving only skin and subcutaneous tissue. The depth of dissection documented in the operative report determines the correct code, with 24065 reimbursing significantly higher.

How many RVUs is CPT code 24065 worth?

CPT 24065 has a total of 7.75 RVUs in 2025, consisting of 2.13 work RVUs, 5.33 practice expense RVUs (non-facility), and 0.29 malpractice RVUs. In the facility setting, practice expense RVUs are 2.52, making the facility total RVUs 4.94.

Can CPT 24065 be billed with an E/M code on the same day?

Yes, but only if the E/M service is separately identifiable from the pre-procedural assessment. Append modifier 25 to the E/M code and ensure documentation clearly shows the evaluation was distinct from the routine pre-biopsy workup. If the decision for surgery was made during the E/M visit, modifier 57 may be appropriate instead.

What diagnosis codes support medical necessity for CPT 24065?

Common supporting diagnosis codes include M79.89 (soft tissue disorder of upper arm), D48.1 (neoplasm of uncertain behavior of connective tissue), D21.1 (benign neoplasm of connective tissue of upper limb), C49.1 (malignant neoplasm of connective tissue of upper limb), and R22.31 (localized swelling, mass and lump, right upper limb) or R22.32 (left upper limb). The diagnosis should reflect the clinical reason for biopsy.

Is ultrasound guidance separately billable with CPT 24065?

No, imaging guidance such as ultrasound (76942) or fluoroscopy (77002) is typically bundled into CPT 24065 per NCCI edits and should not be billed separately. The reimbursement for 24065 includes the work of localizing and targeting the lesion.

What is the global period for CPT 24065?

CPT 24065 has a 10-day global period. This means follow-up visits within 10 days of the procedure are included in the reimbursement and should not be billed separately unless unrelated to the biopsy or addressing a complication requiring return to the operating room (which would require modifier 78 or 79).