Complete replantation of a traumatically amputated forearm, reattaching bone, vessels, nerves, and soft tissue.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $2,899.20
- Total RVUs
- 86.8
- Global, days
- 90
- Region
- Hand
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Level of amputation — clearly stated as complete forearm amputation, not partial or digital
- Mechanism and extent of injury, including contamination, crush vs. sharp transaction, and ischemic time
- Operative note must name every structure repaired: bone fixation method, arteries and veins anastomosed, nerves repaired, tendons/muscles addressed
- Total operative time and, if modifier 22 is used, documentation of the specific factors that increased complexity beyond a typical replant
- Ischemia time from amputation to re-establishment of perfusion, recorded in the operative note
- Post-operative vascular assessment findings (Doppler signals, capillary refill) to support medical necessity and establish baseline for follow-up claims
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
CPT 20805 covers complete replantation of the forearm following traumatic amputation. The work includes skeletal fixation, arterial and venous anastomosis, nerve repair, and soft-tissue closure — all as a single operative episode. Because of the complexity and operative time involved, this code carries one of the highest RVU values in the musculoskeletal section.
The 90-day global period applies. That means all routine post-operative visits, wound care, and suture removal through day 90 are bundled. Any separate procedure during that window for a distinct, unrelated problem requires modifier 79. A return to the OR for a related complication — vascular thrombosis takedown, wound debridement tied to the original replant — requires modifier 78.
Bilateral replantation is theoretically possible but clinically rare; if it occurs, modifier 50 applies. Modifier 22 is appropriate when operative complexity substantially exceeds the typical procedure — document operative time, number of vessel anastomoses, and specific complicating factors explicitly in the operative note to support it.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 50.17 |
| Practice expense RVU | 25.91 |
| Malpractice RVU | 10.72 |
| Total RVU | 86.8 |
| Medicare national rate | $2,899.20 |
| 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 | $2,899.20 |
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 20805 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note describes a partial amputation or revascularization without true replantation — use 20802 or 35671 instead
- Modifier 22 submitted without documentation of specific complexity factors; 'difficult case' language alone is insufficient
- Post-operative follow-up visits billed without modifier 24 or 79 during the 90-day global period
- Bilateral modifier 50 applied without documentation that both forearms were replanted at the same operative session
- Return-to-OR claim submitted with modifier 79 (unrelated) when the revisit was for a complication of the original replant — modifier 78 is required in that scenario
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What is the difference between CPT 20805 and CPT 20802?
02Can 20805 be billed with revascularization codes on the same day?
03When is modifier 22 justified for a forearm replantation?
04How does the 90-day global period affect post-replant care billing?
05Is 20805 reported differently in a hospital outpatient vs. ASC setting?
06What ICD-10 codes are required to support 20805?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-faq-library
- 04cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
Mira AI Scribe
Mira's AI scribe captures amputation level (complete forearm), ischemia time, mechanism of injury, and an itemized list of structures repaired — bone fixation technique, named arteries and veins anastomosed, nerves repaired, and tendon/muscle work. That specificity prevents downcoding to revascularization-only codes and provides the paper trail needed if modifier 22 is appended for unusual complexity.
See how Mira captures CPT 20805 documentation