2025 CPT code 20225
(Active) Effective Date: N/A Revision Date: N/A Surgery - General Excision Procedures on the Musculoskeletal System Musculoskeletal System Feed
Bone biopsy using a trocar or needle for deep tissue (e.g., vertebral body, femur).
Modifiers may be applicable depending on the specific circumstances of the procedure (e.g., modifier 59 for a distinctly separate procedure, modifier 76 for a repeat procedure).Refer to the CPT manual for guidance.
Medical necessity for a bone biopsy (20225) is established when there is a clinical suspicion of bone disease (e.g., infection, tumor, metabolic bone disease), and the biopsy is deemed essential for proper diagnosis and treatment planning.The decision to perform the biopsy should be based on a comprehensive evaluation of the patient's clinical presentation, imaging studies, and other relevant factors.Documentation must support the medical necessity.
The physician or qualified healthcare professional is responsible for appropriate patient preparation and anesthesia, identifying the biopsy site, making a small incision, inserting and positioning the biopsy needle or trocar into the bone, extracting the tissue sample, and closing the incision. They also submit the specimen to the laboratory for pathological analysis.
In simple words: A doctor takes a small sample of bone from deep inside your body (like your spine or thigh bone) using a thin needle or tube to check for bone disease.
This CPT code describes a bone biopsy procedure where a trocar or needle is used to obtain a sample of bone tissue from deep locations such as the vertebral body or femur.The procedure involves accessing the bone with a needle or trocar, extracting a tissue sample, and submitting it for laboratory analysis to diagnose bone diseases.The approach is minimally invasive.
Example 1: A 65-year-old female presents with persistent back pain and suspected vertebral compression fracture. A bone biopsy (20225) is performed to rule out malignancy or other pathology., A 70-year-old male with a history of Paget's disease undergoes a bone biopsy (20225) from the femur to assess disease progression and monitor treatment response., A 30-year-old male sustains a femur fracture with suspicious bone lesions.Prior to surgical repair, a bone biopsy (20225) is performed to obtain a tissue sample for histopathological analysis to guide surgical planning and treatment.
* Detailed history and physical examination documenting the indication for the biopsy.* Imaging studies (e.g., X-ray, CT, MRI) identifying the specific location for the biopsy.* Operative report detailing the technique used, the site and depth of the biopsy, and the specimen's handling.* Pathology report with the microscopic examination results of the specimen.* Appropriate pre- and post-operative care notes.
** The use of a trocar or needle is essential for this code; other biopsy methods are represented by other codes.Always ensure proper documentation to support medical necessity and accurate coding.
- Revenue Code: P5B (Ambulatory Procedures - Musculoskeletal)
- RVU: The relative value units (RVUs) for CPT code 20225 vary depending on geographic location, the setting of service (e.g., hospital outpatient department, physician’s office), and specific Medicare Administrative Contractor (MAC) policies.Consult current fee schedules for precise values.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a complete procedure.
- Fee Schedule: Historical fee schedule data varies by payer and location.Consult fee schedules for specific historical information.
- Specialties:Orthopedic surgery, pathology, oncology, radiology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center