Removal of bone for graft

CPT code 20900 covers the surgical removal of bone tissue from one part of a patient's body to be used as a graft in another area. This is the harvesting procedure for autologous (self-donated) bone grafts.

Showing rates for

National Average

Base Medicare rate

$368.75

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

PE RVU (NF)

7.9

MP RVU

0.5

Total RVU

11.4

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

NCCI bundling edits

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Billing tips

Always verify payer-specific policies regarding 20900 bundling with primary procedures. Many payers bundle bone graft harvesting into spinal fusion codes (22590-22634) unless performed at a structurally separate site.
Impact: $368.75 at risk if bundled incorrectly; modifier 59 with proper documentation can recover this amount
Document the exact anatomical harvest site with specificity (e.g., 'left posterior iliac crest' not just 'hip'). Include measurements of bone harvested and separate incision details to support distinct procedural service.
Impact: Reduces audit risk and denial rate by 40-60%; critical for modifier 59 support and separate reimbursement justification
Bill non-facility (office/ASC) when applicable to capture the $193.43 differential. The higher PE RVU (7.9 vs 1.92) reflects equipment and supply costs that only non-facility settings can claim.
Impact: $193.43 additional reimbursement per case in non-facility setting versus hospital facility
For Medicare patients, understand that 20900 has a 10-day global period. Related E/M services within this window require modifier 24 if unrelated to the bone graft harvest.
Impact: Prevents unbundling denials for follow-up visits; preserves E/M reimbursement with proper modifier use
When bone graft harvesting is performed bilaterally from separate sites (rare), append modifier 50 instead of billing 20900 twice. Verify payer accepts modifier 50 for this code.
Impact: Typically yields 150% of single procedure rate ($553.13) versus risk of denial for duplicate billing
Cross-reference the primary procedure code with CMS NCCI edits quarterly. The Column 1/Column 2 relationships change and affect whether 20900 can be billed separately.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 20900 in 2025?

The 2025 Medicare national average reimbursement for CPT 20900 is $368.75 in non-facility settings and $175.32 in facility settings. This difference reflects the practice expense RVU variation between settings (7.9 non-facility vs 1.92 facility).

Can CPT 20900 be billed with spinal fusion codes?

Yes, but with important limitations. CPT 20900 can be billed separately from spinal fusion codes (22590-22634) only when the bone graft is harvested from a structurally separate incision and distinct anatomical site from the fusion site. Modifier 59 is typically required, and documentation must clearly support the additional work. Many payers have specific coverage policies restricting this combination.

What modifier should I use when billing CPT 20900 with another procedure?

Modifier 59 is most commonly used when 20900 is billed with another procedure to indicate a distinct procedural service at a separate anatomical site. Modifier 51 may be automatically applied by payers for multiple procedure payment reduction. Modifiers RT/LT specify laterality, and modifier 22 can be used for increased procedural complexity with appropriate documentation.

How many RVUs is CPT code 20900 worth?

CPT 20900 has a total of 11.4 RVUs for 2025, comprised of 3.0 work RVUs, 7.9 non-facility practice expense RVUs (1.92 facility PE RVUs), and 0.5 malpractice RVUs. This makes it a moderate-to-high value procedural code.

Does CPT 20900 require prior authorization?

Prior authorization requirements vary by payer and are not mandated by Medicare for 20900 alone. However, when billed with high-cost primary procedures like spinal fusions, the combined service often requires authorization. Commercial payers increasingly require pre-authorization for any procedure exceeding certain RVU or cost thresholds. Always verify individual payer policies before scheduling.

What documentation is needed to bill CPT 20900 separately?

Documentation must include: the specific anatomical harvest site, separate incision details if different from primary procedure, measurements or volume of bone harvested, type of bone tissue obtained, closure technique for harvest site, medical necessity for autograft, and additional operative time. The operative report must clearly demonstrate work beyond what is included in the primary procedure code.

What are common anatomical sites for bone graft harvest under CPT 20900?

The most common harvest sites include the iliac crest (posterior or anterior), proximal tibia, distal radius, fibula, and rib. The iliac crest is most frequently used due to abundant cancellous bone availability. The choice of site depends on the volume of graft needed, patient anatomy, and surgeon preference. Documentation should specify the exact location and side.