Bone/skin graft iliac crest

CPT code 20970 covers the harvesting of bone and/or skin from the iliac crest (hip bone area) for use as a graft in another part of the body. This is typically performed when a patient needs bone or tissue transplanted from their own body to repair defects or promote healing elsewhere.

Showing rates for

National Average

Base Medicare rate

$2,778.24

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

44.58

PE RVU (NF)

32.19

MP RVU

9.12

Total RVU

85.89

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

NCCI bundling edits

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Billing tips

Always bill 20970 separately from the primary reconstruction procedure - it is NOT included in the global surgical package of the recipient site surgery
Impact: Prevents loss of $2778.24 in legitimate reimbursement that many providers incorrectly assume is bundled
Document the exact location and dimensions of the graft harvested, including whether corticocancellous or cancellous bone was obtained and whether skin was included
Impact: Reduces audit risk by 60-70% and supports medical necessity when reviewers question the separate billing of the harvest procedure
Check CCI edits carefully when billing with spine fusion codes (22558, 22612, 22630) - modifier 59 may be required despite 20970 being separately reportable
Impact: Prevents automatic denials that can delay payment by 30-60 days and require appeals
For commercial payers, verify whether they recognize 20970 as separately reimbursable or if they require use of bone graft codes from the 20900 series instead
Impact: Some payers inappropriately bundle this code, but pre-verification can prevent denials and establish appeal grounds worth the full $2778.24
Document operative time separately for the harvest procedure versus the primary procedure to support medical necessity and justify assistant surgeon billing if applicable
Impact: Strengthens justification for modifier 80 billing ($444.52 for assistant) and supports time-based appeals if denied
Link appropriate diagnosis codes showing the medical necessity for autologous graft rather than allograft or synthetic alternatives (document why alternatives were not suitable)

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 20970 in 2025?

The 2025 Medicare national average reimbursement for CPT 20970 is $2778.24 for both facility and non-facility settings, based on 85.89 total RVUs and the 2025 conversion factor of 32.3465.

Can CPT 20970 be billed with spinal fusion codes?

Yes, CPT 20970 can and should be billed separately with spinal fusion procedures such as 22558, 22612, or 22630 when autologous iliac crest bone graft is harvested. This is a separately reportable procedure, though you may need to append modifier 59 depending on the specific payer and NCCI edits. Always verify that your documentation clearly shows a separate incision and distinct procedural service.

What is the difference between CPT 20970 and 20937?

CPT 20970 specifically describes bone and/or skin graft harvest from the iliac crest, while 20937 covers structural autograft from any site, including spine, rib, or other donor sites. Code 20970 is used when the harvest specifically comes from the iliac crest; 20937 is used for other anatomical harvest sites or when structural bone is obtained from locations other than the ilium.

How many RVUs is CPT code 20970 worth?

CPT 20970 has 85.89 total RVUs for 2025, comprised of 44.58 work RVUs, 32.19 practice expense RVUs (both facility and non-facility), and 9.12 malpractice RVUs. This makes it one of the higher-valued graft harvest procedures in terms of relative value.

Do I need modifier 59 when billing CPT 20970 with a primary procedure?

Modifier 59 may be required when billing CPT 20970 with certain primary procedures if NCCI edits exist that would otherwise bundle the codes. Check the current NCCI edit tables for the specific primary procedure you are billing. Even when not technically required by NCCI, some payers may request modifier 59 to clearly indicate the graft harvest was a distinct procedural service with a separate incision.

Is CPT 20970 included in the global surgical package of the primary procedure?

No, CPT 20970 is NOT included in the global surgical package of the primary reconstruction or fusion procedure. It represents a separate surgical service involving a distinct anatomical site (the iliac crest donor area) and should be billed separately when performed. This is explicitly recognized by Medicare and most payers, though documentation must clearly support the separate nature of the procedure.

What diagnosis codes support medical necessity for CPT 20970?

Medical necessity for CPT 20970 is typically supported by diagnosis codes related to the primary condition requiring bone grafting, such as spinal stenosis (M48.06-M48.07), spondylolisthesis (M43.1x), nonunion/malunion of fractures (M84.x), post-traumatic defects (M96.x), or maxillofacial defects (K08.x, M26.x). The key is documenting why autologous iliac crest bone graft was clinically superior to alternatives such as allograft, demineralized bone matrix, or synthetic bone substitutes for the specific clinical scenario.