20902

Harvesting of a major or large autogenous bone graft from any donor site, performed through a separate skin incision not included in the primary procedure code.

Verified May 8, 2026 · 6 sources ↓

Medicare: $241.82
Total RVUs: 7.24
Global, days: 0
Region: General

Drawn from CMSMdclarityAaomsAAOSAoassn

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific donor site (e.g., iliac crest, fibula, proximal tibia) by anatomic name — 'bone graft harvest site' alone is insufficient.
Document that the harvest was performed through a separate skin incision distinct from the primary procedure incision.
Confirm in the operative note that the primary procedure's CPT descriptor does not already include graft harvesting.
Record the size and quantity of graft harvested to support 'major or large' characterization versus the minor/small threshold of 20900.
Note the primary procedure and its CPT code in the operative report to establish medical necessity for the harvest.
If two surgeons performed distinct parts of the procedure, document each surgeon's specific role to support modifier 62.

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 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

20902 covers the surgical harvest of a major or large bone graft from a donor area — typically the iliac crest, fibula, or tibia — when that harvest is performed through a separate incision and is not already bundled into the primary procedure code. The key billing trigger is the phrase 'not included in the code or descriptor for the primary surgical service.' If the primary code's descriptor already encompasses graft harvesting, 20902 cannot be billed separately.

This code appears across orthopedic surgery, podiatry, and otolaryngology because bone graft harvest is a cross-specialty need. Common primary procedures that legitimately support a separate 20902 include mandibular reconstruction (e.g., 21196) and spinal fusion codes that do not bundle harvest. Do not report 20902 alongside codes like 21210 or 21215, which already include obtaining the graft.

The global period is 000 — zero days — so no follow-up visits are bundled into this code. Modifier 51 applies when 20902 is reported alongside the primary procedure in the same session. Use modifier 59 when a payer challenges medical necessity for separate billing, and document the separate incision explicitly in the operative note.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.47
Practice expense RVU	1.94
Malpractice RVU	0.83
Total RVU	7.24
Medicare national rate	$241.82
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	$241.82
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 20902 get rejected.

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

Primary procedure code already bundles graft harvesting — payer denies 20902 as included in the base code (e.g., 21210, 21215).
Operative note lacks documentation of a separate incision for the donor site, causing payer to treat it as integral to the primary procedure.
Missing or vague characterization of graft size — payers may downcode to 20900 (minor/small) or deny without explicit 'major or large' documentation.
Modifier 51 omitted when billing 20902 alongside the primary procedure in the same session, triggering multiple-procedure edit denial.
Modifier 59 absent when payer flags the code pair as potentially bundled, and no documentation supports distinct procedural service.

Frequently asked questions

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

01When can I bill 20902 separately from the primary procedure?

Only when the primary procedure's CPT descriptor does not already include harvesting the graft. If the primary code bundles harvest, 20902 is not separately billable. Always check the primary code's descriptor and any NCCI edits before adding 20902 to the claim.

02What is the global period for 20902?

Zero days (000). No pre- or post-operative visits are bundled into this code, so follow-up visits related to the donor site are separately billable with standard E/M coding rules.

03What is the difference between 20900 and 20902?

20900 covers a minor or small graft — such as a dowel or button. 20902 is for a major or large harvest. Document the graft size explicitly; vague notes invite a downcode to 20900.

04Should I use modifier 51 when billing 20902 with the primary procedure?

Yes. When 20902 is billed alongside the primary procedure in the same session, modifier 51 (multiple procedures) applies to the lower-RVU code. List the primary procedure with the higher RVU first.

05Can two surgeons bill 20902 separately using modifier 62?

Yes, when two surgeons each perform distinct portions of the harvest — for example, in complex reconstructive cases where a second surgeon harvests while the primary surgeon works at the recipient site. Each surgeon appends modifier 62 to their claim. Confirm modifier 62 eligibility for this code with each payer before billing.

06Does 20902 require a separate incision, or can the harvest incision be shared with the primary procedure?

A separate skin incision at the donor site is required to bill 20902. If the graft is harvested through the same incision as the primary procedure, it is generally considered included in that procedure and cannot be billed separately.

07What modifier applies if 20902 is performed during the postoperative period of a prior surgery due to a complication?

Use modifier 78 if the return to the OR for the graft harvest is related to the original procedure. Use modifier 79 if the harvest is unrelated to the original procedure. Do not invert these — 78 is for related, 79 is for unrelated.

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 by anatomic name, confirms a separate incision was made, and flags the graft size as major or large — the three documentation elements most likely to trigger a denial or downcode. That prevents the most common audit flag: an operative note that describes graft harvest without establishing it was separate from and not bundled into the primary procedure.

See how Mira captures CPT 20902 documentation