Surgical biopsy of deep muscle tissue located below the fascia or beneath adjacent muscles or bone structures.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $338.69
- Total RVUs
- 10.14
- Global, days
- 0
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Explicit documentation that the biopsy site was located deep to the fascia or beneath adjacent muscle or bone — do not rely on implied depth.
- Surgical approach narrative: incision site, planes of dissection, and identification of the target deep muscle by name and anatomic location.
- Size and description of the tissue specimen obtained, confirming adequacy for pathologic evaluation.
- Closure technique documented — wound repair is bundled; do not list it as a separate billable service.
- Medical necessity documented with a working diagnosis or clinical question (e.g., myopathy, inflammatory muscle disease, suspected infection) linking the biopsy to a supported ICD-10-CM code.
- Pathology requisition or report cross-referenced to the operative note to establish a complete audit trail.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
CPT 20205 covers an open biopsy of deep muscle — tissue situated below the fascia or otherwise covered by adjacent muscle or bone. The surgeon incises the overlying skin, dissects through superficial layers, and excises a tissue sample adequate for pathologic analysis. This is not a needle or fine-needle aspiration biopsy; it is an open surgical procedure requiring a formal incision and closure.
The 000 global period means all same-day and next-day post-op services are bundled, but there is no 10- or 90-day follow-up window. If you see the patient back even two days later for a related issue, that visit does not fall inside a global and bills normally. Wound closure is included per NCCI Chapter 5 — do not separately report 12001–13153 for the incision closure.
Do not confuse 20205 with 20200 (superficial muscle biopsy). The depth distinction is the code selector: 20200 is above or within the fascia; 20205 is definitively below it. Operative notes that fail to state depth relative to the fascia are the primary cause of downcoding to 20200 on audit.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 2.29 |
| Practice expense RVU | 7.2 |
| Malpractice RVU | 0.65 |
| Total RVU | 10.14 |
| Medicare national rate | $338.69 |
| Global period | 0 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $338.69 |
HOPD (APC 5073) Hospital outpatient department | $2,967.63 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $1,248.36 |
Common denial reasons
The recurring reasons claims for CPT 20205 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Downcoded to 20200 because the operative note does not explicitly state the biopsy was below the fascia — depth must be named, not inferred.
- Lack of medical necessity when the diagnosis code does not support an open deep biopsy (e.g., superficial or non-muscular condition coded instead of myopathy or deep infection).
- Bundling denial when wound closure code 12001–13153 is billed alongside 20205 — closure is included per NCCI and not separately payable.
- FNA biopsy code billed concurrently for the same lesion on the same encounter — NCCI prohibits reporting both an FNA code and an open biopsy code for the same site.
- Missing or mismatched pathology order — payers auditing medical necessity expect the operative note and path requisition to align on anatomic site and clinical indication.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What separates 20205 from 20200?
02Can I bill wound closure separately with 20205?
03Can 20205 and an FNA code be billed together for the same muscle on the same day?
04What modifiers apply when 20205 is performed bilaterally?
05Is imaging guidance separately billable with 20205?
06What ICD-10-CM codes commonly support medical necessity for 20205?
07Does the 000 global period mean no post-op visits are covered separately?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira AI Scribe
Mira's AI scribe captures the biopsy depth descriptor (below fascia or subfascial), the specific muscle and anatomic region by name, the dissection planes traversed, and the clinical indication driving the procedure. This prevents the most common audit failure on 20205 — an operative note that omits explicit depth documentation, which triggers downcoding to 20200 and leaves reimbursement on the table.
See how Mira captures CPT 20205 documentation