20802

Surgical reattachment of a completely severed arm, spanning from the surgical neck of the humerus through the elbow joint.

Verified May 8, 2026 · 6 sources ↓

Medicare: $2,452.29
Total RVUs: 73.42
Global, days: 90
Region: Shoulder

Drawn from NIHAAPCAAOSCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Level of amputation documented precisely — surgical neck of humerus through elbow joint confirms 20802 rather than a more distal code
Operative note must detail all components addressed: bone fixation method, vessel repair (artery and vein), nerve repair, tendon repair, and skin/soft-tissue closure
If modifier 22 is appended, the note must explicitly state why work exceeded the typical procedure — operative time alone is insufficient
Laterality documented (left or right arm) to support LT or RT modifier and match ICD-10 traumatic amputation code
Mechanism and acuity of injury recorded to establish medical necessity for replantation versus revision amputation
If co-surgeons billed (modifier 62), each surgeon's operative note must describe their distinct, non-overlapping intraoperative role

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon 24 Unrelated E/M during global LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 20802 covers complete replantation of the arm following traumatic amputation, with the anatomic scope running from the surgical neck of the humerus through the elbow joint. The procedure involves restoring bone continuity, vascular inflow and outflow, nerve coaptation, and soft-tissue coverage — a multi-system reconstruction performed under prolonged operative time, typically by a microsurgical team. Because of that complexity, modifier 22 is routinely warranted when operative time or difficulty significantly exceeds the norm, but documentation must quantify why.

The 90-day global period means all routine postoperative management — wound checks, splint or cast changes, therapy coordination visits — is bundled through day 90. Services unrelated to the replantation during that window require modifier 24 (E/M) or 79 (unrelated procedure). A staged or planned return to the OR for a related procedure — flap revision, hardware adjustment — uses modifier 58; an unplanned return for a related complication uses modifier 78.

Billing site matters: HOPD and ASC payment rates differ substantially (see site-of-service comparison table). This procedure is almost exclusively performed in a hospital setting given the trauma context and resource demands, so ASC billing would be unusual and may trigger payer scrutiny. Co-surgeon billing (modifier 62) applies when two surgeons of equal skill perform distinct portions of the procedure — common in replantation when a vascular or plastic surgeon and an orthopedic surgeon divide the work.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	41.55
Practice expense RVU	23.01
Malpractice RVU	8.86
Total RVU	73.42
Medicare national rate	$2,452.29
Global period	90 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	$2,452.29
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$13,933.19

Common denial reasons

The recurring reasons claims for CPT 20802 get rejected.

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

Wrong replantation code selected — 20802 is arm (humerus through elbow); forearm amputations bill 20805 and hand amputations bill 20808; level mismatch triggers denial
Modifier 22 appended without supporting narrative in the operative note quantifying the additional work or time
Global period conflicts — related E/M or procedure billed within the 90-day global without the correct modifier (24, 58, or 78)
Missing or mismatched laterality between the procedure code modifier (LT/RT) and the ICD-10 traumatic amputation diagnosis code
Co-surgeon claims denied when both operative notes describe identical work rather than distinct surgical roles

Frequently asked questions

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

01What distinguishes 20802 from 20805 and 20808?

20802 covers the arm from surgical neck of humerus through the elbow joint. 20805 is the forearm (radius and ulna to radial carpal joint). 20808 is the hand through the metacarpophalangeal joints. The amputation level in the operative note determines which code is correct — don't default to 20802 for any upper-extremity replantation.

02When does modifier 62 apply for replantation?

Use modifier 62 when two surgeons of equal and necessary skill — typically an orthopedic or trauma surgeon and a microsurgical/plastic or vascular surgeon — each perform a distinct portion of the procedure. Both must submit with modifier 62 and each operative note must document their separate, non-overlapping contributions.

03Does the 90-day global include management of replant failure or vascular crisis?

An unplanned return to the OR for a related complication (vascular thrombosis, flap compromise) within the global uses modifier 78. A planned staged procedure — scheduled revision, bone grafting — uses modifier 58. Neither bypasses the global automatically; the modifier is required for separate payment.

04Is modifier 22 routinely supported for arm replantation given its inherent complexity?

Not automatically. Replantation is already valued at a high RVU reflecting its complexity. Modifier 22 requires documentation of work substantially beyond the typical — unusual anatomy, multiple failed vessel anastomoses requiring redo, or prolonged operative time with a specific explanation. Payers will request the operative note; a generic statement of complexity is insufficient.

05Can 20802 be billed in an ASC setting?

Technically payable in an ASC, but traumatic complete arm amputation almost universally requires inpatient hospital resources — blood bank, ICU availability, prolonged anesthesia. ASC billing for this code will likely trigger payer scrutiny and medical necessity review. Confirm site-of-service designation matches where the procedure actually occurred.

06Which ICD-10 diagnosis codes pair with 20802?

Traumatic amputation at the shoulder or upper arm level — ICD-10 codes in the S48 category — are the primary matches. Laterality in the ICD-10 code must align with the LT or RT modifier on the claim. A mismatch between diagnosis laterality and modifier laterality is a common, avoidable denial trigger.

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 exact anatomic level of amputation (surgical neck of humerus through elbow joint), laterality, vascular structures repaired, nerve coaptation details, bone fixation technique, and operative duration from dictation. That prevents the most common denial path for 20802: a note that establishes replantation occurred but omits the structural detail auditors and payers require to confirm code-level accuracy and support any modifier 22 claim.

See how Mira captures CPT 20802 documentation