20808

Surgical reattachment of a completely amputated hand, including all structures from the hand through the metacarpophalangeal joints.

Verified May 8, 2026 · 6 sources ↓

Medicare: $3,479.37
Total RVUs: 104.17
Global, days: 90
Region: Hand

Drawn from CMSEmednyAbosCgsmedicareEatonhand

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: confirm hand through metacarpophalangeal joints — distinguishes 20808 from 20816/20822 (digit) or 20805 (forearm)
Mechanism and time of injury, warm and cold ischemia times documented in the operative note
All structures repaired listed explicitly: bones fixated, vessels anastomosed (artery and vein counts), nerves repaired, tendons reconstructed
Operative note must name the specific microsurgical technique used — loupe vs. microscope magnification, type of fixation, anastomosis method
Pre-op imaging or clinical findings confirming complete amputation and replantation candidacy
Laterality documented — left or right hand — to support LT/RT modifier assignment

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 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

20808 covers complete hand replantation — reattachment of a traumatically amputated hand at or through the metacarpophalangeal joints. The procedure involves skeletal fixation, arterial and venous anastomosis, nerve repair, tendon reconstruction, and soft-tissue closure, typically performed under microscopic magnification. It is one of the highest-RVU surgical codes in the musculoskeletal section.

The 90-day global period applies. All routine post-operative management, wound care, and follow-up visits through day 90 are included in the surgical fee. Separate billing for post-op care in that window requires modifier 24 (E/M unrelated to surgery) or modifier 79 (unrelated return to OR). An unplanned return to the OR for a related complication — vascular compromise, flap failure — uses modifier 78.

Site of service matters significantly here. HOPD and ASC payments differ; see the Site of Service comparison table on this page. Because 20808 is almost always performed in a hospital setting, understand that facility fees are billed separately by the hospital. The surgeon bills the professional component only on the MPFS.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	61.51
Practice expense RVU	29.52
Malpractice RVU	13.14
Total RVU	104.17
Medicare national rate	$3,479.37
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	$3,479.37
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 20808 get rejected.

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

Wrong code level selected — 20805 (forearm) or 20816 (digit) used when the amputation was at the hand through MCP joints
Missing or vague operative note lacking explicit listing of structures repaired, triggering medical necessity denial
Post-op E/M visit billed without modifier 24 during the 90-day global period
Modifier 78 and 79 confused on return-to-OR claims — 78 required for related vascular revision, 79 for unrelated procedure
Laterality modifier omitted — payers requiring LT or RT will deny or suspend the claim without it

Frequently asked questions

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

01What distinguishes 20808 from 20816 or 20822?

20808 is for complete amputation of the entire hand through the metacarpophalangeal joints. 20816 and 20822 cover individual digit replantation (excluding thumb) at different levels. If only a finger was replanted, do not use 20808.

02Can 20808 be billed with digit replantation codes on the same day?

Only if anatomically distinct amputations are replanted — for example, a hand replantation plus a separately amputated digit replanted at the same session. Append modifier 51 to the secondary procedure and document each replantation separately in the operative note.

03Which modifier applies for a return to the OR for vascular compromise of the replanted hand?

Modifier 78 — unplanned return to the OR during the global period for a procedure related to the original surgery. Do not use modifier 79, which is reserved for unrelated procedures.

04Is 20808 ever performed in an ASC?

Rarely in practice — replantation requires a full microsurgical team and blood bank support typically available only in a hospital. ASC payment rates are published (see the Site of Service table), but expect payer scrutiny if this is billed from an ASC.

05Does the 90-day global period cover therapy referrals and splinting after replantation?

No. Hand therapy, custom splinting, and occupational therapy are not physician services and are billed separately by the therapist. The global period covers only the operating surgeon's post-op E/M visits and routine wound management.

06When is modifier 22 appropriate for 20808?

When the procedure required substantially greater work than typical — for example, multilevel vascular reconstruction due to crush mechanism, extensive contamination requiring debridement, or prolonged ischemia requiring vein grafting. Document the specific factors adding time and complexity in the operative note. Without that documentation, payers will deny the upcharge.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures amputation level (hand through MCP joints), ischemia times, laterality, and a structured inventory of all repaired structures — bones, arteries, veins, nerves, and tendons — directly from surgeon dictation. That prevents the vague operative note that auditors flag and that payers use to deny medical necessity on high-RVU microsurgery claims.

See how Mira captures CPT 20808 documentation