Percutaneous bone biopsy of a superficial bone using a trocar or needle, yielding tissue for diagnostic analysis.

Verified May 8, 2026 · 7 sources ↓

Medicare: $223.12
Total RVUs: 6.68
Global, days: 0
Region: General

Drawn from CMSCgsmedicareAAPCMdclarityPcgsoftware

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific bone biopsied by name (e.g., ilium, sternum, rib, spinous process) — 'superficial bone' alone is insufficient.
Document the clinical indication: suspected infection, malignancy, metabolic bone disease, or other specific diagnosis driving the biopsy.
Record the technique: trocar vs. needle type, approach, number of passes, and whether imaging guidance was used.
If imaging guidance was used, include a separate documentation entry describing the modality, real-time imaging, and final needle position.
For bilateral or multi-site biopsies, note each anatomical site distinctly in the operative report to support modifier 59 or XS.
Specify laterality (right vs. left) for any paired bone so RT/LT modifier usage matches the note.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 26 Professional component 50 Bilateral procedure 51 Multiple procedures 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 7 cited references ↓

CPT 20220 covers a needle or trocar-based percutaneous biopsy of a superficial bone — think ilium, sternum, spinous process, or ribs. The surgeon advances the instrument through skin and soft tissue to extract cortical or cancellous bone for pathologic evaluation. Because access is percutaneous rather than open, this is the superficial counterpart to 20225, which applies to deeper targets like the vertebral body or femur. Choose the code based on the bone approached, not the technique variation.

The global period is 000, meaning standard post-op follow-up is not bundled. Every related E/M or procedure visit after the biopsy day is separately billable — but document medical necessity for each. Imaging guidance (fluoroscopy, CT, ultrasound) used to direct needle placement is not bundled into 20220 by default; report the appropriate guidance code separately and document its use in the operative note to survive NCCI scrutiny.

When the same biopsy code is needed for two anatomically distinct sites on the same date, modifier 59 (or XS for a separate structure) separates the lines. Modifier 51 applies when 20220 is the secondary procedure in a multi-procedure encounter. Payers vary on whether they accept 51 or require 59 in that scenario — know your payer mix before defaulting to one.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.61
Practice expense RVU	4.9
Malpractice RVU	0.17
Total RVU	6.68
Medicare national rate	$223.12
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	$223.12
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 20220 get rejected.

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

Missing laterality modifier (RT or LT) on paired bones causes payer suspension for manual review.
Imaging guidance billed without documentation of real-time use triggers NCCI bundling denial.
Duplicate claim denial when 20220 is reported twice for multi-site biopsies without modifier 59 or XS to establish distinct sites.
Modifier 51 omitted when 20220 is a secondary procedure, resulting in downcoding or denial of the secondary line.
Diagnosis code mismatch — vague or unspecified bone lesion ICD-10 code not supporting medical necessity for biopsy.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What separates 20220 from 20225?

The bone approached, not technique. 20220 is for superficial bones (ilium, sternum, ribs, spinous processes). 20225 covers deep targets like the vertebral body or femur. If your operative note names the bone, the selection is straightforward.

02Can imaging guidance be billed separately with 20220?

Yes, when guidance is separately documented with real-time imaging notation and final needle position confirmed. Without that documentation, NCCI edits can bundle the guidance code into 20220. Check the specific guidance CPT for its modifier indicator before billing.

03If two superficial bone biopsies are done at different sites the same day, how do you bill?

Report 20220 twice. Append modifier 59 (or XS if the sites are anatomically distinct structures) to the second line. Payers vary — some accept 51, some require 59. Document each site by name in the operative note. Without that, the second line looks like a duplicate.

04Does 20220 have a global period requiring post-op visit bundling?

No. The global period is 000, so only the day of the procedure is included. Post-operative visits are separately billable from the next day forward, provided they're documented with medical necessity.

05When does modifier 26 apply to 20220?

When the physician interprets the biopsy results or provides the professional service without owning or staffing the technical equipment. Radiology-based biopsies billed split-component between a radiologist and a facility are the most common scenario.

06Is modifier 50 ever appropriate for 20220?

Rarely, but yes — if biopsies are taken from the same superficial bone on both sides of the body (bilateral ribs, for example) during one session. Confirm the payer accepts 50 vs. requiring RT and LT on separate lines before submitting.

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 bone biopsied by name, the instrument used (trocar vs. needle), number of passes, laterality, and whether imaging guidance directed the procedure — all from dictation. That prevents the two most common denial triggers: missing laterality and undocumented guidance when a guidance code is billed alongside 20220.

See how Mira captures CPT 20220 documentation