How much does Medicare pay for CPT 20206?

Medicare allowed an average of $63.35 per service and paid $49.01 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $629.33, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 20206?

Needle biopsy of muscle. It was billed 1,585 times to 1,556 Medicare beneficiaries by 105 providers in 2024.

Does 20206 pay differently in an office than a hospital?

Yes. The allowed amount averaged $87.30 in an office setting and $57.78 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 20206 most?

Diagnostic Radiology, with 919 services from 60 clinicians. Next are Interventional Radiology, Physician Assistant, Nurse Practitioner.

CPT 20206

Needle biopsy of muscle

$63.35Medicare-allowed amount per service, averaged across 1,585 services

Providers submitted

$629.33

Asking price, not received

Medicare allowed

$63.35

The fee schedule figure

Medicare paid

$49.01

Balance is patient coinsurance

Providers submitted an average of $629.33 for this code and Medicare allowed $63.35 — 9.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $49.01 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $87.30
Hospital / facility: $57.78

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 299 services were billed in an office setting and 1,286 in a facility.

Services: 1,585
Beneficiaries: 1,556
Providers billing it: 105
Total allowed: $100,410

What Medicare pays for CPT 20206

Across 1,585 services billed by 105 providers to 1,556 beneficiaries, Medicare allowed an average of $63.35 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 20206

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	919	903	$63.06	60
Interventional Radiology	403	393	$55.26	26
Physician Assistant	188	186	$57.12	13
Nurse Practitioner	27	27	$43.37	2
Radiation Oncology	13	13	$45.33	1
Internal Medicine	13	12	$56.24	1
Surgical Oncology	11	11	$64.70	1
Ambulatory Surgical Center	11	11	$568.51	1

20206 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	265	$55.67	$40.74	16
Texas	229	$66.55	$51.67	15
New York	228	$59.67	$40.25	9
California	125	$57.09	$37.86	10
Arizona	97	$68.79	$54.26	7
Tennessee	78	$72.90	$65.95	6
Massachusetts	73	$54.17	$37.75	5
Missouri	66	$51.31	$40.86	4
Illinois	66	$52.57	$39.10	5
Delaware	42	$53.82	$40.80	2
Washington	36	$55.45	$39.64	3
West Virginia	27	$50.13	$41.97	2
Pennsylvania	26	$57.63	$43.64	2
New Jersey	25	$58.53	$43.02	2
Arkansas	24	$287.21	$242.94	2
Maryland	24	$59.63	$42.03	2
Minnesota	24	$54.87	$43.00	2
Michigan	23	$55.11	$43.98	2
South Carolina	23	$42.96	$34.24	2
Oklahoma	13	$54.31	$40.81	1
Mississippi	13	$47.48	$37.40	1
Kansas	13	$51.87	$44.00	1
Colorado	12	$45.62	$35.88	1
Iowa	11	$49.36	$41.97	1
Georgia	11	$53.12	$42.04	1
Connecticut	11	$215.56	$170.93	1

Related codes

20245Biopsy of deep bone$250.74
20225Deep biopsy of bone$167.34

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.