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20220
Quick jump to procedure code: Printer Friendly Version
2022F

CPT® 20225: BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR)

Short Description: Bone biopsy trocar/needle

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$534.55
$112.50

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 JulyUnadjusted OPPS Payment $1414.28
2016 July Unadjusted ASC Payment $790.85


*Based on National 2013 Medicare Part B submitted claims.
Revenue Code(s):
490-Ambulatory surgical care-general classification


2016 APC Code: 5074
Level 4 Excision/ Biopsy/ Incision and Drainage

2016 OPPS Status Indicator: T

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
20.5% 733.90    Disorder of bone and cartilage, unspecified M89.9   Disorder of bone, unspecified
OR:
M94.9   Disorder of cartilage, unspecified
6.1% 733.13    Pathologic fracture of vertebrae M48.50XA   Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for fracture
OR:
M80.08XA   Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
OR:
M84.48XA   Pathological fracture, other site, initial encounter for fracture
OR:
M84.68XA   Pathological fracture in other disease, other site, initial encounter for fracture
5.0% 805.4    Fracture of vertebral column without spinal cord injury, lumbar, closed S32.009A   Unspecified fracture of unspecified lumbar vertebra, initial encounter for closed fracture
4.2% 805.2    Fracture of vertebral column without spinal cord injury, dorsal (thoracic), closed S22.009A   Unspecified fracture of unspecified thoracic vertebra, initial encounter for closed fracture
4.1% 198.5    Secondary malignant neoplasm of bone and bone marrow C79.51   Secondary malignant neoplasm of bone
OR:
C79.52   Secondary malignant neoplasm of bone marrow
2.7% 733.00    Osteoporosis, unspecified M81.0   Age-related osteoporosis without current pathological fracture
2.2% 733.99    Other disorder of bone and cartilage M89.30   Hypertrophy of bone, unspecified site
OR:
M89.8X9   Other specified disorders of bone, unspecified site
OR:
M94.8X9   Other specified disorders of cartilage, unspecified sites
2.0% 238.0    Neoplasm of uncertain behavior of bone and articular cartilage D48.0   Neoplasm of uncertain behavior of bone and articular cartilage
2.0% 239.2    Neoplasms of unspecified nature of bone, soft tissue, and skin D49.2   Neoplasm of unspecified behavior of bone, soft tissue, and skin
1.8% 174.9    Malignant neoplasm of breast (female), unspecified C50.919   Malignant neoplasm of unspecified site of unspecified female breast

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

20225 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

CCI Edits for 20225
Denied Codes (1)
Effective
Modifier
Accepted (2)
0171T Lumbar spine proces distract
04/01/2008 Yes
0200T Perq sacral augmt unilat inj
04/01/2011 Yes
0201T Perq sacral augmt bilat inj
04/01/2011 Yes
11010 Debride skin at fx site
01/01/1998 Yes
11011 Debride skin musc at fx site
01/01/1998 Yes
11012 Deb skin bone at fx site
01/01/1998 Yes
0213T Njx paravert w/us cer/thor
07/01/2010 No
0216T Njx paravert w/us lumb/sac
07/01/2010 No
0228T Njx tfrml eprl w/us cer/thor
10/01/2010 No
0230T Njx tfrml eprl w/us lumb/sac
10/01/2010 No
12001 Rpr s/n/ax/gen/trnk 2.5cm/<
10/01/2012 Yes
12002 Rpr s/n/ax/gen/trnk2.6-7.5cm
10/01/2012 Yes
12004 Rpr s/n/ax/gen/trk7.6-12.5cm
10/01/2012 Yes
12005 Rpr s/n/a/gen/trk12.6-20.0cm
10/01/2012 Yes
12006 Rpr s/n/a/gen/trk20.1-30.0cm
10/01/2012 Yes
12007 Rpr s/n/ax/gen/trnk >30.0 cm
10/01/2012 Yes
12011 Rpr f/e/e/n/l/m 2.5 cm/<
10/01/2012 Yes
12013 Rpr f/e/e/n/l/m 2.6-5.0 cm
10/01/2012 Yes
12014 Rpr f/e/e/n/l/m 5.1-7.5 cm
10/01/2012 Yes
12015 Rpr f/e/e/n/l/m 7.6-12.5 cm
10/01/2012 Yes
12016 Rpr fe/e/en/l/m 12.6-20.0 cm
10/01/2012 Yes
12017 Rpr fe/e/en/l/m 20.1-30.0 cm
10/01/2012 Yes
12018 Rpr f/e/e/n/l/m >30.0 cm
10/01/2012 Yes
12020 Closure of split wound
10/01/2012 Yes
12021 Closure of split wound
10/01/2012 Yes
12031 Intmd rpr s/a/t/ext 2.5 cm/<
10/01/2012 Yes
12032 Intmd rpr s/a/t/ext 2.6-7.5
10/01/2012 Yes
12034 Intmd rpr s/tr/ext 7.6-12.5
10/01/2012 Yes
12035 Intmd rpr s/a/t/ext 12.6-20
10/01/2012 Yes
12036 Intmd rpr s/a/t/ext 20.1-30
10/01/2012 Yes
12037 Intmd rpr s/tr/ext >30.0 cm
10/01/2012 Yes
12041 Intmd rpr n-hf/genit 2.5cm/<
10/01/2012 Yes
12042 Intmd rpr n-hf/genit2.6-7.5
10/01/2012 Yes
12044 Intmd rpr n-hf/genit7.6-12.5
10/01/2012 Yes
12045 Intmd rpr n-hf/genit12.6-20
10/01/2012 Yes
12046 Intmd rpr n-hf/genit20.1-30
10/01/2012 Yes
12047 Intmd rpr n-hf/genit >30.0cm
10/01/2012 Yes
12051 Intmd rpr face/mm 2.5 cm/<
10/01/2012 Yes
12052 Intmd rpr face/mm 2.6-5.0 cm
10/01/2012 Yes
12053 Intmd rpr face/mm 5.1-7.5 cm
10/01/2012 Yes
12054 Intmd rpr face/mm 7.6-12.5cm
10/01/2012 Yes
12055 Intmd rpr face/mm 12.6-20 cm
10/01/2012 Yes
12056 Intmd rpr face/mm 20.1-30.0
10/01/2012 Yes
12057 Intmd rpr face/mm >30.0 cm
10/01/2012 Yes
13100 Cmplx rpr trunk 1.1-2.5 cm
10/01/2012 Yes
13101 Cmplx rpr trunk 2.6-7.5 cm
10/01/2012 Yes
13102 Cmplx rpr trunk addl 5cm/<
10/01/2012 Yes
13120 Cmplx rpr s/a/l 1.1-2.5 cm
10/01/2012 Yes
13121 Cmplx rpr s/a/l 2.6-7.5 cm
10/01/2012 Yes
13122 Cmplx rpr s/a/l addl 5 cm/>
10/01/2012 Yes
13131 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13132 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13133 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13151 Cmplx rpr e/n/e/l 1.1-2.5 cm
10/01/2012 Yes
13152 Cmplx rpr e/n/e/l 2.6-7.5 cm
10/01/2012 Yes
13153 Cmplx rpr e/n/e/l addl 5cm/<
10/01/2012 Yes
20220 Bone biopsy trocar/needle
01/01/1996 Yes
24300 Manipulate elbow w/anesth
10/01/2002 Yes
25259 Manipulate wrist w/anesthes
10/01/2002 Yes
26340 Manipulate finger w/anesth
10/01/2002 Yes
36000 Place needle in vein
10/01/2002 Yes
36400 Bl draw < 3 yrs fem/jugular
04/01/2009 Yes
36405 Bl draw <3 yrs scalp vein
04/01/2009 Yes
36406 Bl draw <3 yrs other vein
04/01/2009 Yes
36410 Non-routine bl draw 3/> yrs
10/01/2002 Yes
36420 Vein access cutdown < 1 yr
04/01/2009 Yes
36425 Vein access cutdown > 1 yr
04/01/2009 Yes
36430 Blood transfusion service
04/01/2009 Yes
36440 Bl push transfuse 2 yr/<
04/01/2009 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
36600 Withdrawal of arterial blood
04/01/2009 Yes
36640 Insertion catheter artery
04/01/2009 Yes
38220 Bone marrow aspiration
07/01/2008 Yes
38221 Bone marrow biopsy
07/01/2008 Yes
43752 Nasal/orogastric w/tube plmt
04/01/2009 Yes
49010 Exploration behind abdomen
01/01/1997 No
51701 Insert bladder catheter
10/01/2007 Yes
51702 Insert temp bladder cath
10/01/2007 Yes
51703 Insert bladder cath complex
10/01/2007 Yes
62310 Inject spine cerv/thoracic
04/01/2009 No
62311 Inject spine lumbar/sacral
04/01/2009 No
62318 Inject spine w/cath crv/thrc
10/01/2002 No
62319 Inject spine w/cath lmb/scrl
10/01/2002 No
64400 N block inj trigeminal
04/01/2009 No
64402 N block inj facial
04/01/2009 No
64405 N block inj occipital
04/01/2009 No
64408 N block inj vagus
04/01/2009 No
64410 N block inj phrenic
04/01/2009 No
64413 N block inj cervical plexus
04/01/2009 No
64415 N block inj brachial plexus
10/01/2002 No
64416 N block cont infuse b plex
01/01/2003 No
64417 N block inj axillary
10/01/2002 No
64418 N block inj suprascapular
04/01/2009 No
64420 N block inj intercost sng
04/01/2009 No
64421 N block inj intercost mlt
04/01/2009 No
64425 N block inj ilio-ing/hypogi
04/01/2009 No
64430 N block inj pudendal
04/01/2009 No
64435 N block inj paracervical
04/01/2009 No
64445 N block inj sciatic sng
04/01/2009 No
64446 N blk inj sciatic cont inf
04/01/2009 No
64447 N block inj fem single
04/01/2009 No
64448 N block inj fem cont inf
04/01/2009 No
64449 N block inj lumbar plexus
04/01/2009 No
64450 N block other peripheral
10/01/2002 Yes
64461 Pvb thoracic single inj site
01/01/2016 No
64463 Pvb thoracic cont infusion
01/01/2016 No
64479 Inj foramen epidural c/t
04/01/2009 No
64483 Inj foramen epidural l/s
04/01/2009 No
64486 Tap block unil by injection
01/01/2015 No
64487 Tap block uni by infusion
01/01/2015 No
64488 Tap block bi injection
01/01/2015 No
64489 Tap block bi by infusion
01/01/2015 No
64490 Inj paravert f jnt c/t 1 lev
01/01/2010 No
64493 Inj paravert f jnt l/s 1 lev
01/01/2010 No
64505 N block spenopalatine gangl
04/01/2009 No
64508 N block carotid sinus s/p
04/01/2009 No
64510 N block stellate ganglion
04/01/2009 No
64517 N block inj hypogas plxs
04/01/2009 No
64520 N block lumbar/thoracic
04/01/2009 No
64530 N block inj celiac pelus
04/01/2009 No
69990 Microsurgery add-on
06/05/2000 No
92012 Eye exam establish patient
04/01/2014 Yes
92014 Eye exam&tx estab pt 1/>vst
04/01/2014 Yes
93000 Electrocardiogram complete
04/01/2009 Yes
93005 Electrocardiogram tracing
04/01/2009 Yes
93010 Electrocardiogram report
04/01/2009 Yes
93040 Rhythm ecg with report
04/01/2009 Yes
93041 Rhythm ecg tracing
04/01/2009 Yes
93042 Rhythm ecg report
04/01/2009 Yes
93318 Echo transesophageal intraop
04/01/2009 Yes
93355 Echo transesophageal (tee)
01/01/2015 Yes
94002 Vent mgmt inpat init day
04/01/2009 Yes
94200 Lung function test (mbc/mvv)
04/01/2009 Yes
94250 Expired gas collection
04/01/2009 Yes
94680 Exhaled air analysis o2
04/01/2009 Yes
94681 Exhaled air analysis o2/co2
04/01/2009 Yes
94690 Exhaled air analysis
04/01/2009 Yes
94770 Exhaled carbon dioxide test
04/01/2009 Yes
95812 Eeg 41-60 minutes
04/01/2009 Yes
95813 Eeg over 1 hour
04/01/2009 Yes
95816 Eeg awake and drowsy
04/01/2009 Yes
95819 Eeg awake and asleep
04/01/2009 Yes
95822 Eeg coma or sleep only
04/01/2009 Yes
95829 Surgery electrocorticogram
04/01/2009 Yes
95955 Eeg during surgery
04/01/2009 Yes
96360 Hydration iv infusion init
01/01/2009 Yes
96361 Hydrate iv infusion add-on
04/01/2016 Yes
96365 Ther/proph/diag iv inf init
01/01/2009 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
96366 Ther/proph/diag iv inf addon
04/01/2016 Yes
96367 Tx/proph/dg addl seq iv inf
04/01/2016 Yes
96368 Ther/diag concurrent inf
04/01/2016 Yes
96372 Ther/proph/diag inj sc/im
01/01/2009 Yes
96374 Ther/proph/diag inj iv push
01/01/2009 Yes
96375 Tx/pro/dx inj new drug addon
01/01/2009 Yes
96376 Tx/pro/dx inj same drug adon
04/01/2009 Yes
99148 Mod sed diff phys/qhp<5 yrs
10/01/2009 No
99149 Mod sed diff phys/qhp 5/>yrs
10/01/2009 No
99150 Mod sed diff phys/qhp add on
10/01/2009 No
99211 Office/outpatient visit est
07/01/2013 Yes
99212 Office/outpatient visit est
07/01/2013 Yes
99213 Office/outpatient visit est
07/01/2013 Yes
99214 Office/outpatient visit est
07/01/2013 Yes
99215 Office/outpatient visit est
07/01/2013 Yes
99217 Observation care discharge
07/01/2013 Yes
99218 Initial observation care
07/01/2013 Yes
99219 Initial observation care
07/01/2013 Yes
99220 Initial observation care
07/01/2013 Yes
99221 Initial hospital care
07/01/2013 Yes
99222 Initial hospital care
07/01/2013 Yes
99223 Initial hospital care
07/01/2013 Yes
99231 Subsequent hospital care
07/01/2013 Yes
99232 Subsequent hospital care
07/01/2013 Yes
99233 Subsequent hospital care
07/01/2013 Yes
99234 Observ/hosp same date
07/01/2013 Yes
99235 Observ/hosp same date
07/01/2013 Yes
99236 Observ/hosp same date
07/01/2013 Yes
99238 Hospital discharge day
07/01/2013 Yes
99239 Hospital discharge day
07/01/2013 Yes
99241 Office consultation
07/01/2013 Yes
99242 Office consultation
07/01/2013 Yes
99243 Office consultation
07/01/2013 Yes
99244 Office consultation
07/01/2013 Yes
99245 Office consultation
07/01/2013 Yes
99251 Inpatient consultation
07/01/2013 Yes
99252 Inpatient consultation
07/01/2013 Yes
99253 Inpatient consultation
07/01/2013 Yes
99254 Inpatient consultation
07/01/2013 Yes
99255 Inpatient consultation
07/01/2013 Yes
99291 Critical care first hour
07/01/2013 Yes
99292 Critical care addl 30 min
07/01/2013 Yes
99304 Nursing facility care init
07/01/2013 Yes
99305 Nursing facility care init
07/01/2013 Yes
99306 Nursing facility care init
07/01/2013 Yes
99307 Nursing fac care subseq
07/01/2013 Yes
99308 Nursing fac care subseq
07/01/2013 Yes
99309 Nursing fac care subseq
07/01/2013 Yes
99310 Nursing fac care subseq
07/01/2013 Yes
99315 Nursing fac discharge day
07/01/2013 Yes
99316 Nursing fac discharge day
07/01/2013 Yes
99334 Domicil/r-home visit est pat
07/01/2013 Yes
99335 Domicil/r-home visit est pat
07/01/2013 Yes
99336 Domicil/r-home visit est pat
07/01/2013 Yes
99337 Domicil/r-home visit est pat
07/01/2013 Yes
99347 Home visit est patient
07/01/2013 Yes
99348 Home visit est patient
07/01/2013 Yes
99349 Home visit est patient
07/01/2013 Yes
99350 Home visit est patient
07/01/2013 Yes
99374 Home health care supervision
07/01/2013 Yes
99375 Home health care supervision
07/01/2013 Yes
99377 Hospice care supervision
07/01/2013 Yes
99378 Hospice care supervision
07/01/2013 Yes
99446 Interprof phone/online 5-10
01/01/2014 No
99447 Interprof phone/online 11-20
01/01/2014 No
99448 Interprof phone/online 21-30
01/01/2014 No
99449 Interprof phone/online 31/>
01/01/2014 No
99495 Trans care mgmt 14 day disch
01/01/2014 Yes
99496 Trans care mgmt 7 day disch
01/01/2014 Yes
G0364 Bone marrow aspirate &biopsy
07/01/2008 Yes
G0463 Hospital outpt clinic visit
07/01/2014 Yes
G0471 Ven blood coll snf/hha
07/01/2015 Yes
J0670 Inj mepivacaine hcl/10 ml
07/01/2010 Yes
J2001 Lidocaine injection
07/01/2004 Yes
20240 Bone biopsy excisional
01/01/1996 Yes
20245 Bone biopsy excisional
01/01/1996 Yes
20250 Open bone biopsy
01/01/1996 Yes
20251 Open bone biopsy
01/01/1996 Yes
22510 Perq cervicothoracic inject
01/01/2015 Yes
22511 Perq lumbosacral injection
01/01/2015 Yes
22512 Vertebroplasty addl inject
01/01/2015 Yes
22513 Perq vertebral augmentation
01/01/2015 Yes
22514 Perq vertebral augmentation
01/01/2015 Yes
22515 Perq vertebral augmentation
01/01/2015 Yes
23200 Resect clavicle tumor
01/01/2010 Yes
23210 Resect scapula tumor
01/01/2010 Yes
23220 Resect prox humerus tumor
01/01/2010 Yes
24150 Resect distal humerus tumor
01/01/2010 Yes
24152 Resect radius tumor
01/01/2010 Yes
25170 Resect radius/ulnar tumor
01/01/2010 Yes
26250 Extensive hand surgery
01/01/2010 Yes
26260 Resect prox finger tumor
01/01/2010 Yes
26262 Resect distal finger tumor
01/01/2010 Yes
27067 Remove/graft hip bone lesion
04/01/2011 Yes
27075 Resect hip tumor
01/01/2010 Yes
27076 Resect hip tum incl acetabul
01/01/2010 Yes
27077 Resect hip tum w/innom bone
01/01/2010 Yes
27078 Rsect hip tum incl femur
01/01/2010 Yes
27236 Treat thigh fracture
01/01/1996 Yes
27244 Treat thigh fracture
01/01/1996 Yes
27245 Treat thigh fracture
01/01/1996 Yes
27269 Optx thigh fx
01/01/2008 Yes
27303 Drainage of bone lesion
01/01/1996 Yes
27355 Remove femur lesion
01/01/1996 Yes
27356 Remove femur lesion/graft
01/01/1996 Yes
27357 Remove femur lesion/graft
01/01/1996 Yes
27360 Partial removal leg bone(s)
01/01/1996 Yes
27365 Resect femur/knee tumor
01/01/1996 Yes
27448 Incision of thigh
01/01/1996 Yes
27450 Incision of thigh
01/01/1996 Yes
27454 Realignment of thigh bone
01/01/1996 Yes
27455 Realignment of knee
01/01/1996 Yes
27457 Realignment of knee
01/01/1996 Yes
27465 Shortening of thigh bone
01/01/1996 Yes
27466 Lengthening of thigh bone
01/01/1996 Yes
27468 Shorten/lengthen thighs
01/01/1996 Yes
27470 Repair of thigh
01/01/1996 Yes
27472 Repair/graft of thigh
01/01/1996 Yes
27475 Surgery to stop leg growth
01/01/1996 Yes
27479 Surgery to stop leg growth
01/01/1996 Yes
27485 Surgery to stop leg growth
01/01/1996 Yes
27506 Treatment of thigh fracture
01/01/1996 Yes
27507 Treatment of thigh fracture
01/01/1996 Yes
27511 Treatment of thigh fracture
01/01/1996 Yes
27513 Treatment of thigh fracture
01/01/1996 Yes
27514 Treatment of thigh fracture
01/01/1996 Yes
27519 Treat thigh fx growth plate
01/01/1996 Yes
27640 Partial removal of tibia
01/01/1996 Yes
27641 Partial removal of fibula
01/01/1996 Yes
27645 Resect tibia tumor
01/01/2010 Yes
27646 Resect fibula tumor
01/01/2010 Yes
27647 Resect talus/calcaneus tum
01/01/2010 Yes
27730 Repair of tibia epiphysis
04/01/2011 Yes
27732 Repair of fibula epiphysis
04/01/2011 Yes
27734 Repair lower leg epiphyses
04/01/2011 Yes
27740 Repair of leg epiphyses
04/01/2011 Yes
27742 Repair of leg epiphyses
04/01/2011 Yes
28005 Treat foot bone lesion
01/01/1996 Yes
28116 Revision of foot
01/01/1996 Yes
28120 Part removal of ankle/heel
01/01/1996 Yes
28122 Partial removal of foot bone
01/01/1996 Yes
28130 Removal of ankle bone
01/01/1996 Yes
28140 Removal of metatarsal
01/01/1996 Yes
28171 Resect tarsal tumor
01/01/1996 Yes
28173 Resect metatarsal tumor
01/01/1996 Yes
28175 Resect phalanx of toe tumor
01/01/2010 Yes
28320 Repair of foot bones
01/01/1996 Yes
62267 Interdiscal perq aspir dx
01/01/2009 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 20225.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 20225


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 4 4 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Clinical: Data Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   20225 Top 5 Ordering Providers National*
GERALD GRUBBS -SARASOTA,FL 92
KURT MADSEN -TERRE HAUTE,IN 75
ERIC LIS -NEW YORK,NY 54
JACK JENNINGS -SAINT LOUIS,MO 35
ALEC GOLDENBERG -NEW YORK,NY 34

   20225 Top 5 Ordering Organizations National*
MIDWEST SURGERY CENTER, LLC-MO 21

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 20225*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 15,116
Total Services Denied 2015: 1,419 (9.4%)
National Charges Submitted 2015: $ 13,624,869.00
National Charges Allowed 2015: $ 1,739,420.00
National Average (No Modifier) Fee Submitted 2015: $814.51
National Average (No Modifier) Fee Allowed 2015: $134.66
National Average (26) Fee Submitted 2015: $1339.00
National Average (26) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 10,673 70.6% $838.71 624 5.8%
Interventional radiology
(eff 5/92)
2,001 13.2% $882.19 115 5.7%
Orthopedic surgery 979 6.5% $1383.95 206 21.0%
Podiatry 461 3.0% $895.77 179 38.8%
Neurosurgery 343 2.3% $1337.68 93 27.1%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Outpatient hospital 8,332 55.1% $898.42 671 8.1%
Inpatient hospital 6,095 40.3% $885.92 760 12.5%
Office 668 4.4% $1375.89 95 14.2%
Ambulatory surgical center 219 1.4% $1998.69 54 24.7%
Emergency room - hospital 75 0.5% $839.16 2 2.7%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 11,275 74.6% $814.52 866 7.7%
GC 1,074 7.1% $1364.00 33 3.1%
59 - Distinct Procedural Service 802 5.3% $1194.77 136 17.0%
51 - Multiple Procedures 592 3.9% $1129.28 69 11.7%
LT - Left Side 326 2.2% $1009.39 46 14.1%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


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