2025 CPT code 20220
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - General Excision Procedures Musculoskeletal System Feed
Superficial bone biopsy using trocar or needle; examples include ilium, sternum, spinous process, ribs.
Modifiers may be applicable depending on the circumstances of the procedure. Consult the CPT manual and payer guidelines for specific modifier usage.
Medical necessity for a bone biopsy is established when there is a clinical suspicion of a bone-related condition that requires further histological examination, such as infection, tumor, or other bone pathology. Imaging studies (e.g., X-rays, CT scans, MRI) often support the clinical suspicion and are typically required prior to the procedure.
The physician or qualified healthcare professional is responsible for prepping the patient, making the incision, obtaining the bone sample using a trocar or needle, and closing the incision.The physician may also be responsible for interpreting the preliminary results, although separate billing for this service is not allowed if a formal pathological evaluation is performed.
In simple words: This code describes a minor surgical procedure to take a small sample of bone from near the surface of the body for testing.A tiny cut is made, a special needle is used to get the sample, and the cut is closed. The sample is then sent to a lab for examination.
This CPT code, 20220, represents a superficial bone biopsy procedure performed using a trocar or needle to obtain a bone tissue sample from superficial areas such as the ilium, sternum, spinous processes, or ribs. The procedure involves a small skin incision, insertion of the instrument to acquire the bone specimen, and closure of the incision.The acquired tissue is then sent to a laboratory for pathological analysis.This code excludes deep bone biopsies or bone marrow biopsies.
Example 1: A patient presents with a suspected bone infection in the rib. A superficial bone biopsy (CPT 20220) is performed to obtain a tissue sample for culture and sensitivity testing., A patient presents with a suspicious lesion on the ilium.A superficial bone biopsy (CPT 20220) is performed to rule out malignancy., During a surgical procedure on the sternum, a suspicious area is discovered. A superficial bone biopsy (CPT 20220) is performed to further characterize the tissue.
* Detailed history and physical examination noting the reason for the biopsy.* Precise location of the biopsy site.* Description of the technique used (trocar or needle).* Size and appearance of the specimen obtained.* Indication for the biopsy.* Pathology report with detailed microscopic findings.* Operative report detailing the procedure.* Anesthesia record.
** This code is used for superficial bone biopsies only.Depth of the biopsy is crucial for accurate code selection.Ensure the type of biopsy (bone vs. bone marrow) is correctly determined as these have different coding.
- Revenue Code: P6B (Minor Procedures - Musculoskeletal)
- RVU: Consult the CMS Physician Fee Schedule for the most current RVUs.These values vary by geographic location and may be affected by various factors including facility type (inpatient vs. outpatient).
- Global Days: The global period for this procedure is not explicitly defined in the CPT guidelines and may vary by payer.Clarification should be sought from the specific payer.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is a complete procedure.
- Fee Schedule: Fee schedules vary significantly based on location, payer, and year.Historical fee data should be sourced from publicly available fee schedules or payer-specific data.
- Specialties:Orthopedics, Pathology, Oncology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center