Removal of fascia for graft

CPT code 20922 covers the surgical removal of fascia (connective tissue layer) from one part of the body to use as a graft in another location. This tissue is typically harvested from areas like the thigh or abdomen and transplanted to repair damaged or missing tissue elsewhere.

Showing rates for

National Average

Base Medicare rate

$602.29

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

6.93

PE RVU (NF)

10.12

MP RVU

1.57

Total RVU

18.62

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

NCCI bundling edits

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Billing tips

Always verify that fascia harvesting is not bundled into the primary procedure code; many complex hernia repairs and reconstructive procedures include graft harvest in their base descriptor
Impact: Prevents automatic denials and potential audit flags; can save $602 in incorrect billing that would need to be refunded
Document the exact dimensions of harvested fascia (length x width in centimeters) and specific anatomical harvest site in operative report
Impact: Critical for medical necessity determination; lack of specificity is leading cause of denial, potentially losing entire $602.29 reimbursement
Bill in facility setting when procedure is hospital-based to align with lower overhead expectations; use POS 22 or 24 appropriately
Impact: Ensures correct rate application ($492.31 facility vs $602.29 non-facility); incorrect POS may trigger $109.98 overpayment recovery
When billing with primary reconstructive procedure, append modifier 59 and ensure separate documentation clearly establishes distinct procedural service
Impact: Prevents NCCI bundling edits; proper modifier use preserves full allowable versus 100% denial ($602.29 at stake)
For bilateral fascia harvesting, verify payer policy on modifier 50 versus RT/LT; Medicare typically does not recognize bilateral for this code
Impact: Prevents claim rejection and reprocessing delays; incorrect bilateral billing may result in payment for single side only
Cross-reference LCD policies in your MAC jurisdiction for specific coverage criteria related to autologous versus synthetic graft requirements

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 20922 in 2025?

The 2025 Medicare national average reimbursement for CPT 20922 is $602.29 in the non-facility setting and $492.31 in the facility setting, based on 18.62 total RVUs and the 2025 conversion factor of 32.3465.

Can CPT 20922 be billed with hernia repair codes?

Yes, but only when fascia harvesting is performed as a distinct procedure separate from the hernia repair and not included in the primary code descriptor. You must append modifier 59 and document a separate harvest site and incision. Many complex hernia codes include graft placement, so verify the primary code does not bundle harvest.

What documentation is required to bill CPT 20922?

Required documentation includes the specific anatomical harvest site, exact dimensions of fascia removed, separate incision description, medical necessity for autologous graft, dissection technique, tissue condition, donor site closure details, and clear indication this was distinct from the primary procedure.

How many RVUs is CPT code 20922 worth?

CPT 20922 has 18.62 total RVUs for 2025, consisting of 6.93 work RVUs, 10.12 non-facility practice expense RVUs (6.72 facility PE RVUs), and 1.57 malpractice RVUs. This represents substantial surgical work requiring detailed documentation.

What modifier should I use when billing 20922 with another procedure?

Use modifier 59 (or XS if your payer accepts X-modifiers) when fascia harvest is performed at a distinct anatomical site from the primary procedure. Also consider modifier 51 for multiple procedures, though modifier 59 typically takes precedence to prevent bundling. Always verify NCCI edits for your specific code combination.

Is CPT 20922 bundled with other codes?

CPT 20922 has numerous NCCI edits and may be bundled with certain reconstructive procedures, hernia repairs, and other grafting codes. Always check the current NCCI edit tables for your specific primary procedure code. Proper use of modifier 59 and documentation of distinct sites is essential to unbundle when appropriate.

What is the difference between facility and non-facility rates for 20922?

The non-facility rate ($602.29) applies when performed in office or physician-owned surgical centers where the practice bears overhead costs. The facility rate ($492.31) applies in hospital settings where the facility bills separately for overhead. The $109.98 difference reflects the practice expense RVU variation between settings.