Manual preparation and insertion of a drug-delivery device into the intramedullary canal of a bone, reported as an add-on to the primary procedure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $147.97
Total RVUs: 4.43
Global, days
Region: General

Drawn from CMSNIHAAPC

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify intramedullary canal as the anatomical placement site — not just 'wound' or 'bone'
Identify the drug used and confirm it was manually mixed into the delivery device (e.g., antibiotic-impregnated cement beads or rods)
Name the primary procedure code this add-on is appended to; link both in the operative report
Document the fabrication method (cement mixing, shaping into beads/rods/spacer) and quantity of material placed
If staged removal is planned, note that explicitly in the operative report to support modifier 58 on the future removal claim

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 20702 covers the manual fabrication of a drug-delivery device — typically antibiotic-impregnated cement shaped into beads, rods, or similar constructs — and its placement into the intramedullary canal of a bone. It is an add-on code, always reported alongside the primary procedure code (e.g., fracture fixation, debridement, or other open bone surgery). It cannot stand alone on a claim.

The code was introduced into the CPT manual in 2022 alongside its companion codes 20700 (subfascial placement) and 20704 (intra-articular placement). Site of placement drives code selection: intramedullary canal = 20702, deep subfascial wound = 20700, joint space = 20704. Confusing these three is the most common coding error.

Because 20702 carries a ZZZ global period, it inherits the global period of the primary procedure it is appended to. Modifier usage (e.g., 58 for staged procedures) is governed by the primary code's global period, not by 20702 itself. Document the intramedullary location, the drug used, and the preparation method explicitly — vague operative notes that don't specify anatomical placement are a leading cause of payer downcoding or denial.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.44
Practice expense RVU	1.5
Malpractice RVU	0.49
Total RVU	4.43
Medicare national rate	$147.97
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$147.97

Common denial reasons

The recurring reasons claims for CPT 20702 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Billed without a primary procedure code — 20702 is an add-on and cannot be reported alone
Wrong site-of-placement code selected: 20700 (subfascial) or 20704 (intra-articular) chosen when intramedullary placement was performed
Operative note lacks explicit documentation of intramedullary placement, triggering downcoding or medical necessity denial
NCCI bundling conflict when the primary procedure already includes device preparation in its descriptor — verify PTP edits before billing
Payer treats drug-delivery device preparation as a supply or included component of the primary procedure without a separate add-on allowance

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can 20702 be billed by itself?

No. It is an add-on code and must be reported alongside the primary procedure. A standalone claim for 20702 will deny.

02How do I choose between 20700, 20702, and 20704?

Placement site controls code selection. Subfascial wound = 20700. Intramedullary canal = 20702. Intra-articular space = 20704. Document the specific site in the operative note — audit teams will check.

03What global period applies to 20702?

20702 carries a ZZZ global period, meaning it has no independent global period and instead inherits the global of the primary procedure it is billed with.

04Does 20702 require modifier 51?

No. Add-on codes are exempt from modifier 51. Do not append it.

05If the drug-delivery device is removed during a subsequent procedure, how is that reported?

Removal is coded separately using the appropriate removal code for the primary implant or device. If the removal occurs during the global period of the primary procedure, modifier 58 applies when the removal was planned and staged.

06Is the antibiotic or cement material billed separately in addition to 20702?

The drug and carrier material may be billable as supplies depending on the facility and payer. In the physician fee schedule setting, 20702 covers the professional work of preparation and insertion. Verify supply billing rules with your specific payer and facility.

07Which primary procedure codes can 20702 be appended to?

The CPT manual lists parenthetical guidance identifying appropriate primary codes. These include open fracture treatment, bone debridement, and other open musculoskeletal procedures where intramedullary drug delivery is clinically indicated. Check the CPT parentheticals and NCCI PTP edits for the specific primary code you are pairing.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the intramedullary placement site, the specific drug and carrier used (e.g., tobramycin-impregnated cement), and the manual fabrication steps from dictation — the three elements auditors check first. That prevents the most common denial: an operative note that describes a wound placement generically instead of confirming the intramedullary canal.

See how Mira captures CPT 20702 documentation