20822

Surgical reattachment of a completely severed finger (excluding the thumb), restoring bone alignment, vascular continuity, nerve integrity, and tendon function through microsurgical technique.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,602.58
Total RVUs: 47.98
Global, days: 90
Region: Hand

Drawn from CMSMdclarityAAPCFindacodeGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm complete amputation — partial amputations are not reported with this code; document the amputation level explicitly (e.g., distal tip, middle phalanx, proximal phalanx, through sublimis tendon insertion)
Specify which digit was replanted by name and number (e.g., index finger, long finger) — do not rely solely on laterality modifiers without naming the digit in the operative note
Document all structures repaired: bone fixation method, arterial and venous anastomoses (number of vessels), nerve repair, and tendon repair — missing any one component invites medical necessity challenges
Record the condition of the amputated part at the time of surgery (warm vs. cold ischemia time, contamination level, crush vs. guillotine mechanism) — payers and auditors scrutinize replantation viability decisions
If modifier 22 is appended, the operative note must quantify what made the work substantially greater than typical (e.g., multi-level vascular injury, revision after failed initial anastomosis, pediatric vessel caliber)
When an assistant surgeon bills modifier 80, confirm the operative note lists the assistant by name and role — assistant surgeon claims without corresponding primary surgeon documentation are routinely denied

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side 62 Co-surgeons

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 20822 covers complete replantation of a non-thumb digit — from the distal tip through the sublimis tendon insertion level — following traumatic amputation. The procedure requires microsurgical repair of bone, flexor and extensor tendons, digital arteries and veins, and digital nerves. It is performed under general or regional anesthesia in a hospital operating room equipped for microsurgery, and routinely requires an assistant surgeon given the complexity of simultaneous skeletal fixation and vascular anastomosis.

The code carries a 90-day global period. All routine postoperative management, dressing changes, and follow-up visits related to the replantation are bundled through day 90. Return trips to the OR for vascular compromise, revision, or secondary tenolysis trigger separate billing: modifier 78 for related unplanned returns, modifier 79 for unrelated procedures during the global window.

20822 does not cover the thumb — use the appropriate thumb replantation code for that digit. It also does not cover incomplete amputations. When multiple non-thumb digits are replanted in the same session, bill 20822 for each digit with modifier 51 on subsequent units, and append LT or RT to lateralize each claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	25.99
Practice expense RVU	16.45
Malpractice RVU	5.54
Total RVU	47.98
Medicare national rate	$1,602.58
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	$1,602.58
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI G2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 20822 get rejected.

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

Incomplete amputation documented in the record — payers deny 20822 when the operative note or ED triage note describes a near-complete or partial amputation rather than a true complete severance
Missing vascular or nerve repair documentation — replantation claims without explicit documentation of arterial anastomosis are frequently downcoded or denied as lacking medical necessity support
Thumb replantation billed under 20822 — the thumb has its own replantation code; using 20822 for a thumb will trigger a claim edit
Global period conflicts — services billed during the 90-day global without appropriate modifier 24, 78, or 79 are automatically bundled and denied
Laterality missing when bilateral digits replanted — claims for multiple digits without LT/RT modifiers or distinct digit identification create ambiguity that payers resolve by denying duplicate-appearing lines

Frequently asked questions

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

01Can 20822 be used for thumb replantation?

No. 20822 explicitly excludes the thumb. Thumb replantation is reported with a separate code. Using 20822 for a thumb will trigger a claim edit at most payers and Medicare.

02If two non-thumb digits are replanted in the same session, how do I bill?

Bill 20822 for each digit. Apply modifier 51 to the second (and each subsequent) procedure line. Append LT or RT to each line and identify the specific digit in the operative note. Some payers require prior authorization for multi-digit replantation — verify before surgery when possible.

03What modifier applies when the patient returns to the OR during the 90-day global because of vascular compromise?

Modifier 78 — unplanned return to the OR for a procedure related to the original replantation during the postoperative period. Reserve modifier 79 for genuinely unrelated procedures that happen to fall within the global window.

04Does 20822 require an assistant surgeon, and how is that billed?

Microsurgical replantation routinely requires an assistant for simultaneous tasks. The assistant bills with modifier 80. The operative note must name the assistant and document their role. Medicare allows assistant surgeon billing for 20822 — confirm with the specific payer for commercial plans.

05What ICD-10 diagnosis codes pair with 20822?

Use a traumatic amputation code from the S68 category (traumatic amputation of finger) specifying the digit, level (partial vs. complete), and laterality. Complete amputation is required — partial amputation codes will not support 20822 and will trigger a denial.

06Is 20822 typically performed in an ASC or hospital setting?

Hospital OR is standard — microsurgical replantation requires equipment, perfusion monitoring, and overnight vascular surveillance that ASCs cannot routinely provide. The HOPD and ASC facility payments differ substantially; see the Site of Service comparison on this page.

07When is modifier 22 appropriate for 20822?

When documented intraoperative circumstances substantially increased surgeon work beyond the typical replantation — for example, multiple-level vascular injuries requiring sequential anastomoses, revision after anastomotic failure, or extreme vessel size mismatch. The operative note must spell out why. A blanket 'complex case' statement will not survive audit.

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 amputation level, ischemia time, digit identity, and a structured list of repaired structures (vessels anastomosed, nerves coaptated, tendons repaired, fixation method) directly from the surgeon's dictation. That structured output prevents the most common audit flag for 20822: an operative note that confirms replantation occurred but fails to document the microsurgical components that justify the code's complexity.

See how Mira captures CPT 20822 documentation