How much does Medicare pay for CPT 20225?

Medicare allowed an average of $167.34 per service and paid $130.78 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1322.35, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 20225?

Deep biopsy of bone using needle or trocar. It was billed 1,009 times to 977 Medicare beneficiaries by 54 providers in 2024.

Does 20225 pay differently in an office than a hospital?

Yes. The allowed amount averaged $295.21 in an office setting and $122.26 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 20225 most?

Diagnostic Radiology, with 661 services from 33 clinicians. Next are Interventional Radiology, Hematology-Oncology, Orthopedic Surgery.

CPT 20225

Deep biopsy of bone using needle or trocar

$167.34Medicare-allowed amount per service, averaged across 1,009 services

Providers submitted

$1322.35

Asking price, not received

Medicare allowed

$167.34

The fee schedule figure

Medicare paid

$130.78

Balance is patient coinsurance

Providers submitted an average of $1322.35 for this code and Medicare allowed $167.34 — 7.9× 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 $130.78 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $295.21
Hospital / facility: $122.26

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. 263 services were billed in an office setting and 746 in a facility.

Services: 1,009
Beneficiaries: 977
Providers billing it: 54
Total allowed: $168,846

What Medicare pays for CPT 20225

Across 1,009 services billed by 54 providers to 977 beneficiaries, Medicare allowed an average of $167.34 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 20225

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	661	645	$177.24	33
Interventional Radiology	299	287	$136.98	18
Hematology-Oncology	20	20	$424.77	1
Orthopedic Surgery	16	13	$65.61	1
General Surgery	13	12	$91.80	1

20225 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
New York	219	$206.22	$137.48	8
California	206	$218.07	$161.14	9
Missouri	125	$120.76	$95.13	5
Minnesota	43	$117.85	$90.95	3
Florida	39	$193.75	$142.73	3
Texas	38	$120.62	$95.30	3
Kansas	37	$114.04	$95.60	2
Ohio	29	$117.66	$96.73	2
Tennessee	28	$348.59	$288.97	1
Illinois	27	$133.39	$97.35	2
Nebraska	27	$95.44	$88.06	2
Virginia	25	$129.15	$97.06	2
New Jersey	23	$135.97	$99.09	2
West Virginia	18	$122.83	$99.07	1
Delaware	17	$119.13	$100.23	1
Connecticut	16	$65.61	$49.47	1
Kentucky	16	$118.97	$99.03	1
New Hampshire	15	$120.39	$86.87	1
Rhode Island	15	$126.02	$98.90	1
Oklahoma	13	$119.15	$99.31	1
North Carolina	11	$119.01	$99.14	1
Mississippi	11	$116.89	$93.37	1
District of Columbia	11	$136.91	$98.85	1

Related codes

20206Needle biopsy of muscle$63.35
20245Biopsy of deep bone$250.74

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.