Surgical reattachment of a completely amputated thumb, spanning the carpometacarpal joint through the MP joint, including repair of bone, vasculature, nerves, and soft tissue.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,841.06
- Total RVUs
- 55.12
- 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 6 cited references ↓
- Amputation level documented by anatomic landmark — confirm proximal extent reaches CMC joint to support 20824 vs. 20827
- Operative note details all structures repaired: bone fixation method, vessel anastomoses (arterial and venous), nerve coaptation, tendon repair
- Laterality specified (right vs. left thumb) to support RT or LT modifier
- Mechanism and timing of injury documented to establish medical necessity for replantation
- Warm and cold ischemia times recorded in the operative note — relevant for payer medical necessity review
- Surgeon's assessment of replantation viability and rationale documented, especially if zone of injury or contamination complicates the case
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 6 cited references ↓
CPT 20824 covers complete replantation of a thumb following traumatic amputation. The procedure spans from the carpometacarpal (CMC) joint to the metacarpophalangeal (MP) joint and involves skeletal fixation, arterial and venous anastomosis, nerve coaptation, tendon repair, and soft tissue closure — all in a single operative episode. It carries a 90-day global period, meaning all routine postoperative care through day 90 is bundled into this code.
This is one of the highest-RVU hand procedures on the fee schedule and is nearly always performed emergently, which affects how the encounter is documented and billed. The decision-for-surgery E/M — if rendered on the same day or the day before — requires modifier 57 to be paid outside the global. Any unplanned return to the OR for a related complication within the 90-day window (e.g., vascular thrombosis requiring re-exploration) should be billed with modifier 78.
Distinguish 20824 from 20827, which covers replantation of the thumb at the distal tip through the MP joint. Billing the wrong code when the amputation level crosses the CMC is a straightforward audit flag. Operative notes must specify the proximal extent of the amputation and the structures repaired.
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 | 17.34 |
| Malpractice RVU | 6.63 |
| Total RVU | 55.12 |
| Medicare national rate | $1,841.06 |
| 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 | $1,841.06 |
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 20824 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Wrong code selected — 20824 billed when amputation level is distal to CMC joint, which maps to 20827
- Missing laterality modifier when payer requires RT or LT on unilateral hand procedures
- Postoperative E/M billed without modifier 24 during the 90-day global period
- Modifier 57 omitted on the same-day decision-for-surgery E/M, causing it to deny as bundled into the global
- Modifier 78 not appended on return-to-OR claims for vascular thrombosis or re-exploration within the global period
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between CPT 20824 and 20827?
02Does the 90-day global include the emergency department evaluation?
03How do you bill a return to the OR for vascular thrombosis during the 90-day global?
04Can modifier 22 be used with 20824?
05Is bilateral thumb replantation billed with modifier 50?
06Where is CPT 20824 typically performed, and does site of service affect payment?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/20824
- 03eatonhand.comhttp://www.eatonhand.com/coding/cpt25.htm
- 04eatonhand.comhttps://www.eatonhand.com/coding/n20824.htm
- 05pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/30928045/
- 06aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
Mira AI Scribe
Mira's AI scribe captures the proximal amputation level relative to the CMC joint, all structures repaired (skeletal fixation method, named vessels anastomosed, nerves coapted, tendons repaired), laterality, ischemia times, and the surgeon's replantation viability rationale. That documentation locks in 20824 vs. 20827 selection and preempts medical necessity denials on payer review.
See how Mira captures CPT 20824 documentation