Replant forearm complete

CPT code 20805 is used when a surgeon reattaches a completely severed forearm, including bone, blood vessels, nerves, and soft tissue. This is an emergency reconstructive procedure performed after traumatic amputation.

Showing rates for

National Average

Base Medicare rate

$3,178.04

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

51.46

PE RVU (NF)

36.27

MP RVU

10.52

Total RVU

98.25

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document total operative time, ischemia time, and specific structures repaired (number of arteries, veins, nerves, tendons) to support medical necessity and potential modifier 22 usage
Impact: Modifier 22 with proper documentation can increase reimbursement by $635-$1,589 above base $3,178.04
Bill co-surgeon arrangements (modifier 62) when two qualified surgeons perform distinct portions; ensure both operative reports clearly delineate separate critical components performed
Impact: Enables each surgeon to receive $1,986.28 instead of splitting single payment, total facility reimbursement $3,972.56
Do not separately bill for skin grafts, nerve repairs, tendon repairs, or vascular anastomoses as these are bundled into 20805; only bill separately for clearly distinct procedures
Impact: Prevents denials and recoupment averaging $500-$2,000 for unbundled components
Verify limb viability documentation including warm ischemia time (ideally <6 hours for forearm) and preservation method in medical record before billing
Impact: Missing viability documentation is primary cause of medical necessity denials resulting in $3,178.04 payment loss
For bilateral forearm replantation (extremely rare), bill 20805 with modifier 50 or bill twice with LT/RT modifiers per payer preference
Impact: Bilateral modifier typically reimburses at 150% ($4,767.06) rather than 200% of base rate
Ensure facility bills appropriate level of emergency department visit (99281-99285) or observation/inpatient admission separately from surgeon's professional component
No direct impact on surgeon reimbursement but prevents facility revenue loss of $200-$1,500 for evaluation services

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 20805 in 2025?

The 2025 Medicare national average reimbursement for CPT 20805 is $3,178.04 for both facility and non-facility settings. This rate is based on 98.25 total RVUs (51.46 work RVU, 36.27 PE RVU, 10.52 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 20805 be billed with a co-surgeon modifier?

Yes, modifier 62 is appropriate when two surgeons of different specialties perform distinct, necessary portions of the forearm replantation simultaneously (such as orthopedic and plastic surgeons). Each surgeon receives 62.5% of the allowed amount ($1,986.28 for Medicare), and both must document their specific contributions in separate operative reports.

What procedures are bundled into CPT 20805 and cannot be billed separately?

CPT 20805 includes all nerve repairs, tendon repairs, vascular anastomoses (arterial and venous), muscle repairs, fasciotomies, and skin closure performed as integral components of the forearm replantation. Separately billing codes for these services will result in unbundling denials and potential recoupment.

How many RVUs is CPT code 20805 worth in 2025?

CPT 20805 has 98.25 total RVUs in 2025, consisting of 51.46 work RVUs, 36.27 practice expense RVUs (both facility and non-facility), and 10.52 malpractice RVUs. This makes it one of the highest-valued CPT codes in the surgical range.

What documentation is required to support medical necessity for forearm replantation?

Required documentation includes mechanism and time of injury, ischemia time (warm and cold), amputated limb viability assessment, preservation method, patient's age and functional demands, absence of contraindications (severe crush injury, multilevel amputation, prolonged ischemia), and rationale for replantation versus revision amputation.

When should modifier 22 be used with CPT 20805?

Modifier 22 is appropriate when the forearm replantation involves substantially greater complexity than typical, such as segmental bone loss, multiple level comminution, extensive soft tissue injury requiring flap coverage, operative time exceeding 12-14 hours, or multiple failed anastomoses requiring revision. Documentation must specify the percentage of additional work (typically 25-50%) and justify the increased complexity.

What is the global period for CPT 20805?

CPT 20805 has a 90-day global surgical period. All routine postoperative care, including dressing changes, cast adjustments, physical therapy orders, and follow-up visits for the replantation, are included in the reimbursement. Only complications or unrelated services can be billed separately during this period, typically with modifier 24 for E/M services or modifier 78/79 for return to OR.