How much does Medicare pay for CPT 20245?

Medicare allowed an average of $250.74 per service and paid $197.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1535.52, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 20245?

Biopsy of deep bone. It was billed 1,472 times to 1,058 Medicare beneficiaries by 41 providers in 2024.

Does 20245 pay differently in an office than a hospital?

Yes. The allowed amount averaged $180.37 in an office setting and $301.80 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 20245 most?

Oral Surgery (Dentist only), with 566 services from 13 clinicians. Next are Orthopedic Surgery, Podiatry, Ambulatory Surgical Center.

CPT 20245

Biopsy of deep bone

$250.74Medicare-allowed amount per service, averaged across 1,472 services

Providers submitted

$1535.52

Asking price, not received

Medicare allowed

$250.74

The fee schedule figure

Medicare paid

$197.59

Balance is patient coinsurance

Providers submitted an average of $1535.52 for this code and Medicare allowed $250.74 — 6.1× 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 $197.59 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $180.37
Hospital / facility: $301.80

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 619 services were billed in an office setting and 853 in a facility.

Services: 1,472
Beneficiaries: 1,058
Providers billing it: 41
Total allowed: $369,089

What Medicare pays for CPT 20245

Across 1,472 services billed by 41 providers to 1,058 beneficiaries, Medicare allowed an average of $250.74 per service. That is 1.4 services per beneficiary, so this is a code patients typically receive more than once. 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 20245

Specialty	Services	Beneficiaries	Avg allowed	Providers
Oral Surgery (Dentist only)	566	364	$175.57	13
Orthopedic Surgery	477	415	$181.98	17
Podiatry	149	87	$289.79	4
Ambulatory Surgical Center	105	45	$921.97	1
General Surgery	61	50	$321.46	2
Plastic and Reconstructive Surgery	61	51	$180.91	2
Maxillofacial Surgery	53	46	$231.62	2

20245 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
California	474	$177.40	$131.61	10
Texas	387	$181.33	$141.66	10
New Jersey	150	$290.61	$227.58	4
Pennsylvania	105	$921.97	$709.09	1
New York	95	$196.11	$141.55	5
Washington	47	$180.55	$132.70	1
Maryland	34	$337.03	$250.80	1
New Mexico	33	$165.02	$132.96	1
Nevada	28	$164.89	$133.52	1
Virginia	25	$306.36	$235.65	1
Tennessee	24	$186.43	$150.20	1
Nebraska	18	$183.86	$147.52	1
Florida	14	$209.50	$162.10	1
South Carolina	14	$205.93	$162.41	1
Kentucky	13	$184.13	$153.99	1
Arizona	11	$193.88	$158.07	1

Related codes

20206Needle biopsy of muscle$63.35
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.