20245

Surgical removal of a bone tissue sample from a deep anatomical site — such as the humeral shaft, ischium, or femoral shaft — through an open incision for pathological analysis.

Verified May 8, 2026 · 6 sources ↓

Medicare: $303.28
Total RVUs: 9.08
Global, days: 0
Region: Other

Drawn from CMSAAPCMdclarityArgonmedical

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 anatomical site by name (e.g., humeral shaft, ischium, femoral shaft) — 'deep bone' alone is insufficient.
Document the surgical approach and confirm the biopsy reached cortical or medullary bone, distinguishing it from a superficial procedure.
State whether the technique was incisional or excisional, even though both bill under 20245.
Record the number of distinct incisions if multiple biopsy sites were sampled in the same session — required to support additional units.
Include pathology order and specimen labeling to link surgical and diagnostic records.
If modifier 22 is appended, document specific intraoperative factors that increased complexity beyond the typical procedure.

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 58 Staged or related 59 Distinct service 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 20245 covers an open biopsy targeting bone at depth — think cortical or medullary sampling from sites like the femoral shaft, humeral shaft, or ischium that require formal surgical exposure rather than a needle or trocar approach. Both incisional and excisional techniques bill under this code; CPT doesn't distinguish between them. The operative note must make the approach and depth explicit to justify 20245 over 20240 (superficial open) or 20225 (needle/trocar deep).

The global period is 000, meaning there is no post-op package — each post-op visit bills separately. If the surgeon performs biopsy at separate anatomical sites through distinct incisions in the same session, report additional units of 20245 with modifier 59 to bypass NCCI bundling edits. If the biopsy confirms a lesion and immediate excision follows in the same session, coding both the biopsy and the excision is supportable — document that the biopsy result drove the surgical decision. For a staged excision after a separate biopsy encounter, append modifier 58 to the excision code.

Site laterality modifiers (LT/RT) are expected whenever the biopsy is unilateral. Bilateral same-session biopsies use modifier 50. When performed during another procedure's post-op period, modifier 78 applies if the return is related; modifier 79 if unrelated.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.85
Practice expense RVU	2.18
Malpractice RVU	1.05
Total RVU	9.08
Medicare national rate	$303.28
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	$303.28
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 20245 get rejected.

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

Upcoding from 20240: payer downcodes to superficial when the operative note lacks explicit depth documentation.
NCCI bundling: multiple same-session bone biopsies denied without modifier 59 on the secondary unit(s).
Missing laterality: payers requiring LT or RT on unilateral procedures reject claims submitted without a side modifier.
Lack of medical necessity: no ICD-10 diagnosis supporting the need for surgical biopsy (e.g., suspected malignancy, osteomyelitis, metabolic bone disease) linked to the claim.
Modifier 22 denial: increased complexity modifier rejected when the operative note does not quantify or describe the additional work performed.

Frequently asked questions

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

01What separates 20245 from 20240?

Depth and site. 20240 covers superficial open biopsies — sternum, spinous process, rib, patella, olecranon, calcaneus, tarsal/metatarsal/carpal bones, phalanges. 20245 is for deep sites requiring greater surgical exposure: humeral shaft, ischium, femoral shaft. If the operative note names a superficial structure, 20240 is the correct code regardless of how difficult the case was.

02Can I bill both 20245 and a lesion excision code on the same date?

Yes, when the biopsy was performed to confirm the diagnosis and the excision followed based on that result in the same session. Document that the biopsy finding drove the surgical decision. For a staged excision at a later encounter, append modifier 58 to the excision code. NCCI guidance explicitly supports this approach.

03If the surgeon biopsies two separate deep bone sites through separate incisions, how do I bill?

Report two units of 20245. Each distinct incision site supports a separate unit. Append modifier 59 to the second unit to override NCCI bundling edits and document each site clearly in the operative report.

04What is the global period for 20245, and does it affect post-op visit billing?

The global period is 000 — zero days. There is no post-op package, so all follow-up visits after the day of surgery bill separately with their appropriate E/M code. You do not need modifier 24 or 79 for routine post-op visits because no global window exists.

05When should I use modifier 22 with 20245?

Only when the operative note documents specific factors that made the procedure substantially more demanding than typical — severe scarring from prior surgery, unusual anatomical complexity, or prolonged operative time with an explained reason. The note must quantify or describe the additional work; a generic statement of difficulty will not survive audit.

06Does 20245 require a separate pathology code, and who bills it?

Surgical pathology (typically 88305 or 88307 depending on complexity) is billed separately by the pathologist or lab performing the analysis. The surgeon or orthopedist bills 20245 for the operative procedure only. Make sure the pathology specimen label matches the anatomical site documented in the operative note.

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 site by anatomical name, the surgical approach, the tissue depth reached, and whether the technique was incisional or excisional — all from dictation. It also flags when multiple incisions were used for separate sites, prompting the coder to consider additional units with modifier 59. This prevents the most common audit trigger: operative notes that document 'deep bone biopsy' without specifying the named structure or confirming cortical/medullary access.

See how Mira captures CPT 20245 documentation