20910

Surgical harvest of costochondral (rib) cartilage for use as an autograft at a separate recipient site.

Verified May 8, 2026 · 8 sources ↓

Medicare: $463.94
Work RVU: 5.39
Global, days: 90
Region: Other

Drawn from CMSAAPCMdclarityAAOSEntnet

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Donor site identified explicitly (e.g., specific rib level) with incision location documented in the operative note
Description of the amount and dimensions of cartilage harvested
Confirmation that the harvesting work was separate and distinct from the recipient-site procedure, especially when billing alongside a primary reconstructive code
Medical necessity narrative explaining why costochondral cartilage was selected over other graft materials
Separate documentation of donor-site closure technique and any complications at the harvest site
Operative note must not simply reference 'graft harvest' generically — audit teams flag notes that omit the specific anatomical donor site and technique

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 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 8 cited references ↓

CPT 20910 covers the harvest-only portion of a costochondral graft procedure — the surgeon makes an incision over the rib, removes the required segment of cartilage and underlying bone, shapes it as needed, and closes the donor site. The code does not include implantation at the recipient site; that work is captured by the primary reconstructive procedure (e.g., rhinoplasty codes in the 30400–30462 range, TMJ reconstruction, or ear reconstruction). When the primary procedure's descriptor explicitly states that graft harvest is included — as with CPT 21230 (rib cartilage graft with reconstruction) — 20910 bundles into it and cannot be billed separately.

20910 carries a 90-day global period. All routine post-op care at the donor site, including dressing changes and suture removal, is included in that global. If a complication at the donor site requires a return to the OR during the global window, append modifier 78 for a related unplanned procedure or modifier 79 for an unrelated one. A decision-for-surgery E/M on the day of or day before the procedure needs modifier 57 appended to the E/M code, not to 20910.

This code appears frequently as an add-on to facial and craniofacial reconstruction cases and to select otolaryngology procedures. The critical billing question every time is whether the primary procedure's descriptor already bundles the harvest — if it does, 20910 is not separately reportable without a modifier and documented distinct service. Payers following NCCI edits will deny the harvest code automatically in those bundled pairings.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.39) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.89) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.39
Practice expense RVU	7.35
Malpractice RVU	1.15
Total RVU	13.89
Medicare national rate	$463.94
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	$463.94
HOPD (APC 5053) Hospital outpatient department	$755.08
ASC (PI A2) Ambulatory surgical center (freestanding)	$404.93

Common denial reasons

The recurring reasons claims for CPT 20910 get rejected.

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

Bundling denial when the primary procedure's descriptor already includes graft harvest (e.g., CPT 21230), and no modifier was appended to establish a distinct service
Lack of documentation supporting a separately identifiable harvest procedure distinct from the reconstructive work
Missing or inadequate medical necessity documentation for choosing a costochondral autograft over alternative materials
Global period conflict when billed during another surgeon's or the same surgeon's active 90-day global without the appropriate modifier (78 or 79)
Incorrect modifier usage — appending modifier 51 when the payer requires modifier 59 or XS to bypass a NCCI PTP edit

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01When can 20910 be billed separately alongside a facial reconstruction code?

Only when the primary procedure's descriptor does not already include graft harvest. CPT 21230, for example, bundles the rib harvest — billing 20910 with it requires a modifier and documented distinct service, or it will deny. Rhinoplasty codes (30400–30462) do not inherently include harvest, so 20910 is separately reportable alongside them when performed.

02Does 20910 have a global period, and what does that cover?

Yes — 90-day global. That includes the operative session, all routine donor-site post-op care, dressing changes, and suture removal through day 90. Unrelated office visits during that window need modifier 24; a new unrelated surgical procedure needs modifier 79.

03What modifier applies if the patient returns to the OR during the global period for a complication at the donor site?

Modifier 78 for an unplanned return to the OR for a complication directly related to the original harvest. Modifier 79 if the return-to-OR procedure is unrelated to the harvest. Do not invert these — modifier 78 is related, modifier 79 is unrelated.

04Is 20910 ever reported with modifier 50?

Rarely, but technically yes if cartilage is harvested bilaterally from two separate rib sites in the same operative session for a procedure requiring bilateral graft material. This is uncommon clinically. Document each harvest site separately in the operative note.

05What is the difference between 20910 and 20912?

20910 is costochondral — cartilage harvested from the rib with its underlying bone. 20912 is nasal septal cartilage harvest. The choice between them depends on the anatomical donor site and the volume and structural properties needed for the recipient site reconstruction.

06Should modifier 22 ever be appended to 20910?

Only when the harvest is substantially more complex than typical — for example, a significantly scarred or previously operated donor field that materially increases operative time and difficulty. Document the specific circumstances in the operative note; payers require written justification, and audit teams will pull the note on modifier 22 claims.

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 rib level, dimensions of the cartilage segment harvested, closure method at the donor site, and an explicit statement that the harvest was performed through a separate incision distinct from the recipient-site work. That detail prevents the automatic bundling denial that hits claims where the operative note doesn't distinguish harvest effort from the primary reconstructive procedure.

See how Mira captures CPT 20910 documentation