20615

Aspiration and injection procedure to treat a bone cyst — fluid is drawn out and a therapeutic agent is injected to promote healing.

Verified May 8, 2026 · 6 sources ↓

Medicare: $249.50
Total RVUs: 7.47
Global, days: 10
Region: General

Drawn from CMSAAPCBedrockbillingPayerpriceEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Pre-procedure imaging (X-ray, CT, or MRI) documenting cyst location, size, and bone integrity
Specific bone and anatomic site of the cyst — not just 'long bone' or 'extremity'
Imaging guidance modality used during the procedure (fluoroscopy, ultrasound), if applicable
Identity and volume of the injected therapeutic agent (corticosteroid, bone-hardening agent, etc.)
Volume and character of fluid aspirated from the cyst
Laterality — left, right, or bilateral — documented explicitly in the procedure note
Medical necessity narrative: prior conservative management, fracture risk, or failed prior aspiration

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 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 20615 covers nonsurgical, percutaneous treatment of a bone cyst: the cyst is aspirated to remove fluid, then a therapeutic substance — corticosteroid, bone-hardening agent, or similar material — is injected to promote healing and reduce recurrence risk. The procedure is typically performed under imaging guidance (fluoroscopy or ultrasound) and is classified under General Introduction or Removal Procedures on the Musculoskeletal System. It carries a 10-day global period, meaning any related E/M visits within that window require modifier 24 to bill separately.

Bone cysts most commonly occur in the metaphysis of long bones and are most frequently treated in pediatric or adolescent patients, though adults present as well. Pre-procedure imaging — X-ray, CT, or MRI — must document cyst location, size, and structural integrity of the surrounding bone. Operative or procedure notes must specify the imaging guidance used, the substance injected, and the volume aspirated. If fluoroscopic guidance is separately reportable, check NCCI edits before stacking guidance codes with 20615.

Site of service matters here. The HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). Office-based performance (POS 11) is common and carries its own RVU-driven reimbursement. If the procedure is performed bilaterally — cysts on corresponding bones on each side — append modifier 50 and document both sites explicitly in the procedure note.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.27
Practice expense RVU	4.95
Malpractice RVU	0.25
Total RVU	7.47
Medicare national rate	$249.50
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	$249.50
HOPD (APC 5071) Hospital outpatient department	$723.47
ASC (PI P3) Ambulatory surgical center (freestanding)	$166.16

Common denial reasons

The recurring reasons claims for CPT 20615 get rejected.

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

Missing pre-procedure imaging to establish medical necessity and cyst diagnosis
Bundling conflict when imaging guidance codes are billed alongside 20615 without verifying NCCI edits
Laterality modifier absent when procedure is performed on a paired bone — payer edits flag unlateralized claims
Insufficient documentation of the injected substance — claims denied when operative note omits agent identity or volume
Repeat procedure billed without modifier 76 (same physician) or 77 (different physician), triggering duplicate claim edits

Frequently asked questions

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

01Can imaging guidance be billed separately with 20615?

It depends on the guidance code. Fluoroscopic guidance (77002) and ultrasound guidance have their own NCCI edit relationships with 20615. Check the NCCI table before billing a guidance code alongside 20615 — some pairs require modifier 59 to bypass the bundle, others are not separately payable regardless.

02What modifier do I use when the same physician repeats the aspiration and injection on the same day?

Append modifier 76 when the same physician performs a repeat aspiration and injection of the same cyst on the same date of service. Use modifier 77 if a different physician performs the repeat. Document the clinical reason for repetition in the note.

03Is 20615 bilateral-billable, and how should I report it?

Yes. If cysts on corresponding paired bones are treated in the same session, append modifier 50 and document both anatomic sites explicitly. Some payers instead require separate line items with LT and RT modifiers — verify your payer's bilateral billing preference before submitting.

04What global period applies to 20615, and what does that mean for post-procedure E/M visits?

20615 carries a 10-day global period. Routine follow-up E/M visits within those 10 days are included in the procedure payment and cannot be billed separately. If a visit within the global period addresses an unrelated problem, append modifier 24 to the E/M code.

05What ICD-10 codes typically support medical necessity for 20615?

M85.50–M85.59 (solitary bone cyst by site) and M85.60–M85.69 (other cyst of bone by site) are the primary diagnosis codes. M85.40–M85.49 covers solitary bone cysts of the hand region. Always code to the highest specificity — include the specific bone and laterality suffix.

06Can 20615 be billed in an office setting, or is it restricted to hospital outpatient or ASC?

20615 is commonly performed in the office (POS 11), outpatient hospital (POS 22), and ASC settings. The procedure note must confirm that imaging guidance equipment was available if a guidance code is billed — an office without fluoroscopy cannot support a 77002 add-on.

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 cyst location by named bone and anatomic region, laterality, imaging guidance modality, the therapeutic agent injected with volume, and the character and volume of aspirated fluid — all from dictation. That prevents the two most common denial triggers: missing site specificity and absent documentation of the injected substance.

See how Mira captures CPT 20615 documentation