Open surgical biopsy of a thoracic vertebral body, requiring an incision to directly access and remove bone tissue for pathological analysis.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $387.45
- Total RVUs
- 11.6
- Global, days
- 10
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Specific thoracic vertebral level biopsied (e.g., T6, T8) documented in the operative note
- Surgical approach described by name — not 'standard approach'
- Clinical rationale for open rather than percutaneous biopsy (e.g., prior needle biopsy failure, need for larger sample, vascular anatomy)
- Specimen handling and disposition to pathology documented, including laterality or level labeling
- Supporting diagnosis with ICD-10 code reflecting the indication (suspected malignancy, osteomyelitis, metabolic bone disease)
- Anesthesia type and patient positioning documented in the operative report
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 20250 covers an open biopsy of the thoracic vertebral body — a surgeon makes a direct incision, exposes the vertebra, and excises a bone tissue sample for laboratory examination. The open approach is chosen when percutaneous needle biopsy (20225) is insufficient, has failed, or when the clinical picture demands a larger, more representative specimen. Indications include suspected primary bone malignancy, metastatic disease, or spinal osteomyelitis where tissue diagnosis will drive treatment.
This is a facility-based procedure performed under general anesthesia. Neurosurgery and orthopedic surgery are the dominant billing specialties. The global period is 10 days — shorter than major spinal procedures but still enough to bundle routine immediate post-op follow-up. CMS NCCI policy is explicit: if a percutaneous needle biopsy (20225) is attempted first at the same encounter and fails, only 20250 is reportable. Do not bill both.
Document the vertebral level, the surgical approach, the reason the open method was selected over percutaneous technique, and the intraoperative specimen disposition. Payers will deny without a supporting diagnosis — malignancy, infection, or metabolic bone disease codes must accompany the claim.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 5.06 |
| Practice expense RVU | 5.08 |
| Malpractice RVU | 1.46 |
| Total RVU | 11.6 |
| Medicare national rate | $387.45 |
| Global period | 10 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 | $387.45 |
HOPD (APC 5113) Hospital outpatient department | $3,342.87 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $1,644.87 |
Common denial reasons
The recurring reasons claims for CPT 20250 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or non-specific ICD-10 diagnosis — payers require a definitive indication such as suspected neoplasm or spinal infection, not just 'back pain'
- CPT 20225 billed same-day: NCCI bundles the percutaneous needle biopsy into 20250 when both are attempted at the same encounter
- Insufficient documentation of the open approach — notes lacking incision description or access method trigger medical necessity denials
- Place of service mismatch — this procedure requires a facility setting; billing with a non-facility POS will trigger payment discrepancies
- Global period overlap — billing a related E/M or minor procedure within the 10-day global without modifier 24 or 78
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What's the difference between 20250 and 20225 for a thoracic vertebral biopsy?
02Is there a lumbar equivalent code for open vertebral body biopsy?
03Can 20250 be billed with a spinal fusion or decompression on the same day?
04What modifiers apply when 20250 is performed during the global period of another spinal procedure?
05Does 20250 require assistant surgeon billing, and which modifier applies?
06What ICD-10 codes typically support medical necessity for 20250?
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 thoracic vertebral level, surgical approach, rationale for open versus percutaneous technique, and specimen disposition directly from dictation. That eliminates the most common audit flag on 20250 — operative notes that omit the access method or fail to justify why needle biopsy wasn't used — and ensures the claim ships with the diagnosis and procedural detail payers require on first pass.
See how Mira captures CPT 20250 documentation