20240

Open surgical biopsy of a superficial bone, such as the ilium, sternum, spinous process, rib, or femoral trochanter, performed through a skin incision to obtain tissue for diagnosis.

Verified May 8, 2026 · 6 sources ↓

Medicare: $126.59
Total RVUs: 3.79
Global, days: 0
Region: General

Drawn from CMSAAPCMdclarityAAOS

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 bone biopsied by name (e.g., ilium, sternum, rib, femoral trochanter) — 'superficial bone' alone is insufficient.
Document the surgical approach: skin incision, exposure method, and confirmation that the bone was directly visualized and accessed.
State whether the biopsy was incisional or excisional and describe the specimen obtained.
If 20240 is billed with a subsequent excision/curettage code, document that the decision to proceed was dependent on intraoperative or pathologic biopsy results.
When multiple biopsies are taken at the same session, document each separate bone site and confirm separate incisions were used for each.
Record medical necessity: clinical indication, suspected diagnosis (infection, neoplasm, metabolic bone disease, etc.) and why open biopsy was required over needle or percutaneous techniques.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 20240 covers an open biopsy of a superficial bone — one accessible without deep dissection, such as the ilium, sternum, spinous process, ribs, or femoral trochanter. The surgeon makes a skin incision, exposes the bone, and removes tissue (incisional or excisional) for pathologic analysis. Both incisional and excisional approaches bill under this code; CPT clarified in 2004 that the work involved is equivalent regardless of biopsy type.

The global period is 000, so any related E/M on the same day requires modifier 25 on the E/M, and no post-op global applies beyond the day of surgery. When the surgeon can't determine whether to proceed with a more extensive procedure — excision, curettage, or tumor removal — until biopsy results confirm the diagnosis, NCCI permits separate reporting of 20240 alongside the subsequent procedure. If that follow-on surgery happens at the same session, append modifier 58 to the excision code to signal staged/dependent intent.

Code selection between 20240 (superficial) and 20245 (deep, e.g., humerus, ischium, femur) hinges on anatomic depth and surgical access — not lesion size. When biopsies are taken from separate bones through separate incisions in the same session, each site is separately reportable. Top billing specialties include podiatry, oral/maxillofacial surgery, and orthopedic surgery, reflecting the range of anatomic sites — foot bones, mandible/maxilla, and long bones — where this code applies.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.54
Practice expense RVU	0.95
Malpractice RVU	0.3
Total RVU	3.79
Medicare national rate	$126.59
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	$126.59
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 20240 get rejected.

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

Superficial vs. deep mismatch: payer or auditor downcodes to 20240 when 20245 is billed, or vice versa, because the operative note doesn't name the bone and confirm its anatomic depth.
Bundling with same-session excision or curettage when the operative note doesn't document that biopsy results drove the decision to proceed — NCCI allows separate reporting only when dependency is explicit.
Missing modifier 25 on a same-day E/M, causing the visit to deny as included in the 000-day global.
Insufficient medical necessity documentation when imaging or prior needle biopsy was available but no explanation for choosing open technique is provided.
Site laterality mismatch between operative report and claim when LT/RT modifiers are used but the documented side differs.

Frequently asked questions

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

01What's the difference between 20240 and 20245?

Depth of the bone biopsied, not lesion size. Superficial bones — ilium, sternum, spinous processes, ribs, femoral trochanter — bill as 20240. Deep bones requiring more extensive dissection — humerus, ischium, femur shaft — bill as 20245. Name the bone in your op note; that's what auditors check first.

02Can 20240 be reported with a same-session excision or curettage code?

Yes, if the decision to perform the excision was dependent on biopsy results. NCCI explicitly permits separate reporting in that circumstance. Document in the operative note that you could not proceed with excision until the biopsy confirmed the diagnosis. For Medicare, append modifier 58 to the excision code.

03Does 20240 cover both incisional and excisional bone biopsies?

Yes. CPT clarified in 2004 that 20240 applies to both incisional and excisional open superficial bone biopsies because the physician work is equivalent. Some payers still call it an 'excisional biopsy code' in their LCDs — check the specific LCD language, but the CPT intent is clear.

04If biopsies are taken from two different superficial bones through separate incisions in the same session, how do you bill?

Report two units of 20240 — one per separate bone site, each accessed through its own incision. Append modifier 51 to the second unit. Document each site and each separate incision explicitly in the operative note.

05Is a same-day E/M billable with 20240?

Yes, but modifier 25 is required on the E/M. The global period for 20240 is 000, so no extended post-op global applies — but the same-day E/M still needs modifier 25 to establish it as a significant, separately identifiable service beyond the pre-procedure assessment.

06Can 20240 be used for a mandible or maxilla biopsy?

It's a common question in oral and maxillofacial surgery. The mandible and maxilla are considered superficial bones given their proximity to the body surface, which supports use of 20240. Oral surgery is one of the top billing specialties for this code per CMS PUF data. Confirm with your MAC LCD if there's specific guidance for jaw bones in your jurisdiction.

07What anesthesia code crosses to 20240?

The ASA Crosswalk maps 20240 to anesthesia code 01480 (anesthesia for open procedures on bones of lower leg, ankle, and foot — used broadly for open musculoskeletal biopsy). Confirm with the crosswalk for the specific anatomic site billed.

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 name, anatomic location, and surgical access method directly from dictation, flags whether the biopsy was incisional or excisional, and notes any dependency language linking the biopsy result to a subsequent same-session procedure. This prevents the most common audit flag for 20240: an operative note that says 'open bone biopsy' without naming the specific bone or justifying the open approach — both of which trigger medical necessity denials and superficial-vs.-deep downcoding disputes.

See how Mira captures CPT 20240 documentation