20816

Replantation of a single digit (excluding the thumb) following complete amputation, covering the metacarpophalangeal joint through the insertion of the flexor sublimis tendon.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,835.71
Total RVUs: 54.96
Global, days: 90
Region: Hand

Drawn from CMSAAOSCgsmedicareEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which digit(s) were replanted by name and number (e.g., long finger, ring finger) and the laterality (left or right hand).
Document the anatomic level of amputation and confirm it falls within the metacarpophalangeal joint to flexor sublimis tendon insertion range.
Confirm complete amputation — partial/incomplete amputations are not reported with this code.
Operative note must detail all components performed: skeletal fixation, tendon repair, vascular anastomosis, nerve repair, and skin closure.
Document the mechanism of injury and time from amputation to replantation, as payers may request this for medical necessity review.
Record ischemia time and viability status of the amputated part at time of replantation attempt.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 62 Co-surgeons 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 ↓

CPT 20816 describes the surgical reattachment of a completely amputated finger — excluding the thumb — at the level spanning from the metacarpophalangeal joint to the insertion of the flexor sublimis tendon. This is a major open microsurgical procedure requiring vascular anastomosis, nerve repair, tendon repair, and skeletal fixation to restore continuity of the digit. The work is substantial, reflected in the high RVU value and the 90-day global period assigned to this code.

The 90-day global covers the day before surgery, the operative session itself, and all related postoperative care through day 90. Any E&M visit for an unrelated condition during that window needs modifier 24. A staged or planned return to the OR for a related procedure needs modifier 78; an unrelated return needs modifier 79. Bilateral digit replantation on the same date requires modifier 50 or LT/RT designations depending on payer rules — confirm with commercial plans.

Code selection within the replantation family (20802–20838) hinges entirely on the anatomic level and completeness of amputation. 20816 is digit-specific, non-thumb, complete amputation only. Incomplete amputations and thumb replantations have their own codes (20822 for distal digit, 20824 and 20827 for thumb levels). Upcoding to a hand-level replantation code (20808) when only a digit was replanted is an audit trigger.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	31.15
Practice expense RVU	17.18
Malpractice RVU	6.63
Total RVU	54.96
Medicare national rate	$1,835.71
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	$1,835.71
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI J8) Ambulatory surgical center (freestanding)	$1,105.94

Common denial reasons

The recurring reasons claims for CPT 20816 get rejected.

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

Wrong code level selected — billing 20816 when the amputation was at the distal tip only (should be 20822) or when the thumb was involved (20824/20827).
Incomplete amputation documented in the operative note — 20816 requires complete amputation; partial replantations are not payable under this code.
Missing laterality or digit identification in the operative report, triggering a documentation-based denial or request for records.
Global period conflict — unbundled post-op visits or related procedures billed without correct modifier (78 or 79) during the 90-day global.
Medical necessity not established — payer requests supporting documentation that replantation was clinically indicated given digit viability and patient functional status.

Frequently asked questions

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

01What is the difference between 20816 and 20822?

20816 covers complete digit amputation at the MCP joint through the flexor sublimis tendon insertion. 20822 covers complete amputation distal to that level — from the flexor sublimis insertion to the fingertip. The anatomic level of the amputation determines the correct code.

02Can 20816 be used for thumb replantation?

No. Thumb replantations are reported with 20824 (carpometacarpal joint to MP joint) or 20827 (distal tip to MP joint). Using 20816 for a thumb replantation is incorrect and will be flagged on audit.

03How do you bill replantation of multiple digits on the same hand during the same operative session?

Report 20816 for the primary digit. For each additional digit replanted at the same level, bill 20816 again with modifier 51 (multiple procedures) and use RT/LT or specific digit modifiers where payer policy requires them. Confirm with your MAC whether modifier 59 is needed to separate the units.

04What modifiers are required for a return to the OR during the 90-day global period?

Use modifier 78 for an unplanned return to the OR for a complication or related procedure (e.g., vascular thrombosis requiring re-exploration). Use modifier 79 for a return to the OR for a completely unrelated procedure. Do not bill routine post-op visits separately — they are included in the global.

05Is 20816 payable in an ASC setting?

Yes. The code has an assigned ASC payment rate. However, given the complexity and typical need for ICU-level monitoring post-replantation, most of these cases are performed in a hospital HOPD setting. Confirm facility privileges and payer contracts before scheduling in an ASC.

06Does the 90-day global include management of replantation failure or digit loss?

Post-op management of complications directly related to the replantation is included in the global. However, if the replanted digit fails and a subsequent amputation or revision procedure is performed, that procedure may be separately reportable with modifier 78 (related, unplanned return to OR) — document clearly that the return was unplanned and necessary due to a complication.

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 digit name and number, hand laterality, amputation level (relative to MCP joint and flexor sublimis insertion), completeness of amputation, and all surgical components performed — vascular anastomosis, nerve repair, tendon repair, and skeletal fixation. That prevents the most common denial pattern for 20816: an operative note that documents the replantation without confirming complete amputation or specifying the correct anatomic level, which triggers a code-level challenge or downcoding to 20822.

See how Mira captures CPT 20816 documentation