Percutaneous needle biopsy of muscle tissue obtained without open incision, used to sample suspected pathology for diagnostic analysis.

Verified May 8, 2026 · 6 sources ↓

Medicare: $209.76
Total RVUs: 6.28
Global, days: 0
Region: General

Drawn from CMSAAPCMdclarity

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact muscle targeted and anatomic location (e.g., left vastus lateralis, right deltoid) — 'muscle biopsy' alone is insufficient.
Document the percutaneous approach explicitly; open biopsy technique would direct to a different code.
If imaging guidance was used, document the modality, real-time visualization, and interpretation separately in a guidance note.
Record the clinical indication — diagnosis, suspected condition, or specific lesion prompting the biopsy.
Note whether an FNA was attempted at the same encounter and the adequacy result, to justify reporting 20206 instead of or in addition to an FNA code.
Pathology requisition or specimen submission record confirming tissue was obtained and sent for analysis.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component 50 Bilateral procedure 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 20206 covers a percutaneous needle biopsy of muscle — a closed technique where a needle is advanced through skin into the target muscle to extract tissue for pathologic evaluation. No open dissection is involved. The code carries a 000-day global period, meaning each encounter is billed independently with no bundled pre- or post-op visits.

Imaging guidance is not included in 20206. If ultrasound, CT, or fluoroscopic guidance is used to direct needle placement, those services are separately reportable — but only if the guidance code descriptor does not already bundle the diagnostic evaluation of that anatomic region performed on the same date. Per NCCI 2026 policy, evaluation of an anatomic region and needle-placement guidance by the same modality in the same region on the same date cannot be split across two codes.

Fine needle aspiration (FNA) codes (10004–10012, 10021) and 20206 cannot both be reported for the same lesion at the same encounter. If an FNA specimen is adequate, no additional biopsy code is reportable. If the FNA is inadequate and a needle biopsy follows, report only one — either the FNA code or 20206, not both.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.97
Practice expense RVU	5.2
Malpractice RVU	0.11
Total RVU	6.28
Medicare national rate	$209.76
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	$209.76
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI A2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 20206 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

FNA code billed same encounter same lesion — NCCI bundles 10004–10012/10021 with 20206 for the same lesion; only one is payable.
Imaging guidance billed without a separate guidance note or when the diagnostic evaluation of that region was already performed by the same modality same date.
Operative note documents an open technique rather than percutaneous needle approach, mismatching the code descriptor.
Missing or vague laterality and anatomic specificity, triggering medical necessity review or edit.
Modifier 26 or TC not applied in split-billing scenarios when the professional and technical components are billed by different entities.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill imaging guidance separately with 20206?

Yes, if the guidance is documented with a separate note and the diagnostic evaluation of that anatomic region was not already reported by the same modality on the same date. NCCI 2026 Chapter 1 and Chapter 6 prohibit bundling evaluation and guidance for needle placement when performed in the same region by the same modality.

02What happens if an FNA was attempted before the needle biopsy at the same visit?

If the FNA specimen was adequate, stop there — 20206 is not separately reportable. If the FNA was inadequate and you proceeded to a needle biopsy, report only one code. NCCI policy prohibits billing both an FNA code and 20206 for the same lesion at the same encounter.

03Does 20206 have a global period that restricts same-day E/M billing?

The global period is 000 days, so there is no 90- or 10-day restriction window. A separately identifiable E/M on the same date can be billed with modifier 25 if it meets the threshold for a distinct service beyond the biopsy decision.

04When does modifier 50 apply to 20206?

Use modifier 50 only if needle biopsies are performed on the same muscle bilaterally in a single session — for example, bilateral deltoid biopsies in a workup for inflammatory myopathy. Document both sites explicitly.

05Is 20206 ever performed by orthopedic surgeons, or is it primarily radiology?

The top billing specialties by volume are Diagnostic Radiology, Interventional Radiology, and Radiation Oncology, reflecting image-guided technique. Orthopedic and neuromuscular specialists do perform the procedure, particularly for myopathy workups, and may bill the professional component with modifier 26 when a radiologist provides technical support.

06Can 20206 be reported with modifier 59 when billed alongside another musculoskeletal procedure on the same date?

Modifier 59 (or XS for a distinct anatomic site) is appropriate only when the biopsy is performed at a genuinely different anatomic site from any co-billed procedure. Different diagnoses alone do not justify modifier 59 under NCCI 2026 policy — the procedures must be in different anatomic regions or separate encounters.

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 target muscle name, anatomic side, needle approach confirmation, imaging guidance modality (if any), and FNA attempt status from physician dictation. This prevents the two most common denials for 20206: missing laterality/site specificity and unbundled FNA-plus-biopsy claims on the same encounter.

See how Mira captures CPT 20206 documentation