Percutaneous bone biopsy using a trocar or needle targeting deep skeletal structures such as the vertebral body or femur.

Verified May 8, 2026 · 6 sources ↓

Medicare: $364.74
Total RVUs: 10.92
Global, days: 0
Region: General

Drawn from CMSAAPCArgonmedicalMdclarityPcgsoftware

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific bone biopsied by name and laterality (e.g., left femoral shaft, L3 vertebral body).
Justify depth classification — document why the target bone meets the deep criterion versus superficial alternatives.
If imaging guidance was used, document the modality, real-time needle visualization, and a permanent record of needle placement (image or fluoroscopic spot).
Record the clinical indication — suspected malignancy, osteomyelitis, metabolic bone disease — to support medical necessity.
Document needle or trocar type used and number of passes or core samples obtained.
Note anesthesia type (local, moderate sedation, general) and whether sedation was separately administered and documented.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 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 20225 covers a percutaneous needle or trocar biopsy of a deep bone — the canonical examples are the vertebral body and femur, but any bone requiring significant soft-tissue traversal to reach qualifies as deep. The depth distinction from 20220 (superficial) is anatomic, not technique-based: superficial targets include the ilium, sternum, spinous process, and ribs, which are accessible with minimal soft-tissue penetration. If you're debating between the two codes, let the bone anatomy drive the decision, not the needle gauge or patient size.

Imaging guidance is frequently used with 20225 but is not included in the code. Fluoroscopy (77002), CT guidance (77012), or ultrasound guidance (76942) should be reported separately with appropriate documentation linking guidance to the biopsy. Failure to document the guidance modality and its direct role in needle placement is the leading reason guidance codes get denied alongside 20225.

The global period is 000 — zero post-op days — so there is no bundling of follow-up visits into the procedure payment. Pathology processing and interpretation are separately reportable. The top billing specialties are diagnostic and interventional radiology and neurosurgery, reflecting how commonly this code is used for spine lesion workups and tumor staging.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.39
Practice expense RVU	8.27
Malpractice RVU	0.26
Total RVU	10.92
Medicare national rate	$364.74
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	$364.74
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 20225 get rejected.

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

Code selected as 20225 (deep) when the biopsied bone (e.g., distal phalanx, rib) meets the superficial descriptor of 20220 — payers flag anatomic mismatch.
Imaging guidance code denied because the operative note lacks documentation of real-time imaging use or a permanent guidance record.
Scope-of-practice denial when the billing provider's specialty is not recognized by the payer as authorized to perform deep bone biopsy at that site.
Missing or insufficient medical necessity documentation — no ICD-10 code linking the biopsy to a specific suspected diagnosis.
Modifier 59 applied to unbundle 20225 from a more comprehensive surgical procedure when the biopsy was integral to that procedure's access.

Frequently asked questions

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

01What is the difference between 20220 and 20225?

The split is anatomic depth. Superficial bones (20220) include the ilium, sternum, spinous process, and ribs — structures reachable with minimal soft-tissue traversal. Deep bones (20225) include the vertebral body and femur, where the needle must pass through significant tissue to reach cortex. The needle type does not determine the code; the target bone does.

02Can I bill imaging guidance separately with 20225?

Yes. Fluoroscopy (77002), CT guidance (77012), and ultrasound guidance (76942) are all separately reportable when used with 20225, provided the operative note documents real-time imaging use and includes a permanent record of needle placement. Without that documentation, expect the guidance code to be denied.

03Does 20225 have a global period that affects same-day billing?

The global period is 000 — zero post-op days. There is no bundling of routine follow-up into the procedure payment, but same-day E/M services must still meet modifier 25 requirements if billed.

04When should I use modifier 59 with 20225?

Use 59 when 20225 is performed at a distinct anatomic site from another procedure billed the same day and would otherwise bundle under NCCI edits. Do not use 59 simply because diagnoses differ — NCCI edits require different anatomic sites or separate encounters to override bundling, not just different ICD-10 codes.

05Is 20225 appropriate for a vertebral biopsy done under CT guidance for suspected metastasis?

Yes. Vertebral body is explicitly cited in the code descriptor as a deep bone. Bill 20225 for the biopsy and 77012 for CT guidance separately. Document the lesion location by vertebral level, the CT-directed needle path, and the clinical suspicion driving the procedure.

06Can 20225 and 20220 both be billed on the same date?

Only if biopsies are performed at genuinely distinct anatomic sites — different bones, not just different levels of the same bone. If both are performed, append modifier 59 or XS to the lower-value code and document each site clearly in the operative note. Billing both for the same bone at the same encounter is incorrect regardless of modifier use.

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 bone by anatomic name and side, depth rationale, needle or trocar type, number of core passes, imaging guidance modality with real-time navigation confirmation, and the clinical indication driving the biopsy. That prevents the two most common 20225 denials: an auditor flagging a superficial bone billed as deep, and a guidance code pulled for lack of documented real-time imaging use.

See how Mira captures CPT 20225 documentation