20900

Minor autogenous bone harvest from a separate donor-site incision — a dowel, button, or similarly small graft quantity.

Verified May 8, 2026 · 9 sources ↓

Medicare: $398.14
Total RVUs: 11.92
Global, days: 0
Region: General

Drawn from CMSAaomsAAPCBedrockbillingCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 9 cited references ↓

Explicitly name the donor site (e.g., right iliac crest, contralateral fibula) — 'bone graft obtained' alone will not survive audit.
State that a separate skin or fascial incision was made at the donor site, distinct from the primary surgical approach.
Describe the graft morphology and approximate size (dowel, button, corticocancellous strut) to support 'minor or small' classification versus 20902.
Confirm the primary procedure code does not include graft harvest in its descriptor — document medical necessity for separate harvest.
Record incision closure technique at the donor site and any complications or additional hemostasis required.
If two surgeons harvested and implanted concurrently, document each surgeon's role to support modifier 62 or 80 as applicable.

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 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 9 cited references ↓

CPT 20900 covers harvesting a minor or small quantity of autogenous bone through a separate skin or fascial incision at any donor site — iliac crest, rib, fibula, or other location — when that harvest is not already bundled into the primary procedure code. The key billing trigger is the separate incision: if the graft comes from bone already exposed or excised as part of the primary procedure (e.g., femoral head during total shoulder arthroplasty), 20900 is not separately reportable.

Before billing 20900 alongside any primary musculoskeletal procedure, confirm that the primary code's descriptor does not already include graft procurement. Per CMS NCCI policy, if a tissue transfer or graft harvest is included in the descriptor of the primary procedure, the harvest code (20900–20924 range) is not separately reportable. Codes like 21210 and 21215 already include obtaining the graft — billing 20900 on top of those is an NCCI violation. When the primary code does not include graft harvest, append modifier 59 (or an X-modifier) to 20900 to establish that it represents a distinct procedural service through a separate incision.

The global period is 000, meaning the day-of and immediate post-procedural care are bundled but there is no 10- or 90-day follow-up global. Because 20900 is almost always an add-on to a larger reconstructive case, site-of-service matters: HOPD and ASC payment differentials are significant — see the Site of Service comparison on this page.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.93
Practice expense RVU	8.51
Malpractice RVU	0.48
Total RVU	11.92
Medicare national rate	$398.14
Global period	0 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	$398.14
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 20900 get rejected.

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

NCCI bundle: primary procedure descriptor already includes graft procurement, making 20900 non-separately payable without a valid modifier.
Missing separate-incision documentation — payers deny when the operative note doesn't distinguish the harvest incision from the primary approach.
Graft sourced from bone already removed during the primary procedure (e.g., excised humeral head), which is not billable as a separate harvest.
Modifier 59 absent or unsupported when 20900 is reported alongside a primary musculoskeletal code that triggers an NCCI PTP edit.
Graft size or quantity not documented, leaving reviewers unable to confirm 20900 (minor) over 20902 (major) — can trigger downcoding or denial.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 9 cited references ↓

01Can I bill 20900 every time my surgeon takes bone graft during a case?

No. Bill 20900 only when the primary procedure code does not already include graft harvest in its descriptor, and only when the bone is obtained through a separate skin or fascial incision. If the primary code bundles graft procurement — as 21210 and 21215 do — 20900 is an NCCI violation regardless of documentation.

02Can 20900 be billed when the graft comes from the excised humeral head during a total shoulder arthroplasty?

No. Bone available from a structure that must be removed to perform the primary procedure is not harvested through a separate incision. Multiple orthopedic coding authorities — AAOS, ASES coding reps, and CMS guidance — are aligned on this point. 20900 requires a distinct donor-site incision.

03What distinguishes 20900 from 20902?

Both cover autogenous bone harvest; 20900 is minor or small (dowel, button), and 20902 is major or large. Document graft size and morphology explicitly. Upcoding to 20902 without documented justification is an audit risk; downcoding to 20900 when a large structural graft was taken leaves RVUs on the table.

04Which modifier do I use when billing 20900 alongside the primary reconstructive procedure?

Modifier 59 (or XS — distinct structural service) is the standard tool to bypass an NCCI PTP edit when the harvest is legitimately separate. The medical record must support it: separate incision, separate site, separate closure. Appending 59 without that documentation invites post-payment audit.

05Does the 000 global period affect how I bill post-op complications at the donor site?

A 000 global means only same-day services are bundled — there is no 10- or 90-day follow-up window. However, if the surgeon returns to the OR for a complication related to the harvest site, bill the return procedure with modifier 78 (unplanned return, related procedure). For an unrelated OR return during any post-op period, use modifier 79.

06If two surgeons are present — one harvesting, one implanting — how do I bill?

If both surgeons perform distinct, non-overlapping portions of a single procedure, modifier 62 (co-surgery) may apply. If one surgeon is assisting rather than performing a co-equal role, modifier 80 or AS (for non-physician practitioners) is appropriate. Document each surgeon's specific intraoperative responsibilities.

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 donor-site name, a discrete description of the harvest incision (location, length, and closure), graft morphology and approximate dimensions, and explicit confirmation that the harvest site was separate from the primary operative field. That documentation prevents the two most common 20900 denials: NCCI bundle challenges asserting no separate incision occurred, and medical-record-level audits that reject the code because the operative note only says 'bone graft obtained.'

See how Mira captures CPT 20900 documentation