Replantation foot complete

CPT code 20838 is used when a surgeon reattaches a completely severed foot, including reconnecting bones, blood vessels, nerves, and soft tissues. This is one of the most complex microsurgical procedures in orthopedic and plastic surgery.

Showing rates for

National Average

Base Medicare rate

$2,716.78

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

42.88

PE RVU (NF)

32.34

MP RVU

8.77

Total RVU

83.99

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

NCCI bundling edits

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Billing tips

Document total operative time, number of vessels repaired (arteries and veins separately), tendons repaired, nerves repaired, and bone fixation method in detail
Impact: Comprehensive documentation supports medical necessity and prevents downcoding; may justify modifier 22 for additional $540-$1,350
Code separately for bone grafting (20900-20902) if autograft harvested from separate site, as this is not bundled with replantation
Impact: Additional $200-$600 in reimbursement depending on graft complexity
Bill for prolonged services (99415-99416) when total procedure time exceeds typical threshold and surgeon remains continuously engaged
Impact: Additional $150-$450 for prolonged services documentation
Verify ischemia time and document reason for replantation versus amputation decision, as payers may question viability beyond 6-hour warm ischemia
Impact: Prevents denial of entire $2,716.78 claim; medical necessity documentation is critical
Use modifier 62 appropriately when two surgeons of different specialties perform distinct portions; both must document their specific contributions separately
Impact: Ensures both surgeons receive $1,698.00 rather than risking denial of second surgeon claim
Do not separately bill for skin grafts (15000 series) performed as part of closure during same operative session, as these are considered bundled
Impact: Prevents unbundling denials and audit flags that could trigger review of entire claim

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 20838 in 2025?

The 2025 Medicare national average reimbursement for CPT 20838 is $2,716.78 for both facility and non-facility settings. This is based on 83.99 total RVUs multiplied by the 2025 conversion factor of 32.3465.

How many RVUs is CPT code 20838 worth?

CPT 20838 has 83.99 total RVUs, consisting of 42.88 work RVUs, 32.34 practice expense RVUs, and 8.77 malpractice RVUs. This makes it one of the highest-valued single procedure codes in orthopedic surgery.

Can two surgeons bill CPT 20838 with modifier 62?

Yes, CPT 20838 commonly supports co-surgeon billing with modifier 62 when surgeons of different specialties perform distinct portions (e.g., orthopedic surgeon for skeletal fixation and plastic surgeon for microvascular anastomoses). Each surgeon receives 62.5% of the allowed amount ($1,698.00) and must document their specific contributions separately.

What documentation is required to bill CPT 20838?

Required documentation includes complete amputation level description, ischemia time, detailed inventory of all repaired structures (specific number and size of arteries, veins, nerves, tendons), bone fixation method, microsurgical technique details with magnification and suture sizes, viability assessment, total operative time, and clinical justification for replantation versus amputation.

Does CPT 20838 include billing for bone grafting?

No, bone grafting from a separate donor site (CPT 20900-20902) can be billed separately with CPT 20838 as it is not bundled. However, you must document the distinct anatomic site and separate incision for graft harvest to avoid unbundling denials.

What is the difference between CPT 20838 and 20816?

CPT 20838 is for complete foot replantation (total amputation), while CPT 20816 is for partial foot replantation. Code 20838 requires complete severance of the foot, typically at or above the ankle level, whereas 20816 involves incomplete amputation where some soft tissue connections remain intact.

How do I bill CPT 20838 if the replantation fails and requires revision?

If return to OR occurs during the global period for complications (thrombosis, arterial/venous revision), use modifier 78 with the appropriate revision procedure code. The original 20838 claim stands as billed. For unrelated return to OR, use modifier 79. Document all complications and medical necessity for return to surgery to support the additional procedure.