Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 20251 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Biopsy Verteb Body Open Lumbar/Cerv
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 20251 |
| Medicaid Fee Schedule | View Medicaid rates for 20251 |
National average reimbursement for CPT 20251 by major payers:
$534.24
$573.73
$598.76
$690.53
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 20251.
CPT 20251
5 of 25 sample ratesHigher to lower in this preview
Portsmouth Surgicenter, LLC
Portsmouth Surgicenter LLC
$9,557.00Published rateTrihealth Hospital, Inc., Trihealth Surgery Center -- Anderson
Trihealth Hospital Inc
$3,162.00Published rateNarrows Surgery Center Ps
Eye M.D.S Of Puget Sound, PLLC
$1,916.00Published rateThe Physicians Rome Surgery Center
$1,463.00Published rateMinimally Invasive Surgery Center, P.A.
$550.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 20251 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20251 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 20251 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 20225-CPT | Moderate | Biopsy Bone Trocar Or Needl, Biopsy Bone Trocar Or Needle Deep (Vertebral Bodyfemur) Biopsy Bone Trocar Or Needle Deep (Vertebral Body |
| 20245-CPT | Moderate | Biops Bone Open; Deep (Eg Humerus Ischium Femur), Biopsy Bone Open; Deep (Eg Humerus Ischium Femur) |
| 20250-CPT | Moderate | Biopsy Vertebral Body Open Thoracic |
| 20251-CPT | Moderate | Biopsy Verteb Body Open Lumbar/Cerv |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20251. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20251 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 20251) and we'll show you how you compare in 15 minutes or less.