CPT 20251 Surgery - Musculoskeletal
Biopsy vrt bdy open lmbr/crv Cost
Body System: Musculoskeletal
Medicare Facility Rate
$421
CMS PFS CY2026
Medicare Non-Facility Rate
$421
Office/clinic setting
Hospital Outpatient
$7
OPPS rate
Surgery Center (ASC)
$3
ASC rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
5.58
Work RVU
5.37
Facility PE RVU
1.66
Malpractice RVU
12.61
Total RVU
Frequently Asked Questions
How much does Biopsy vrt bdy open lmbr/crv cost?
The Medicare facility rate is $421. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $7. Ambulatory surgery center rate: $3.
How much does Biopsy vrt bdy open lmbr/crv cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $421.