20922

Open harvesting of a fascia lata graft by incision and area exposure, complex or sheet graft technique

Verified May 8, 2026 · 6 sources ↓

Medicare: $657.33
Total RVUs: 19.68
Global, days: 90
Region: General

Drawn from CMSKzanowAbosAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm that a separate skin/fascial incision was made to harvest the fascia lata — not the same incision as the primary procedure
Identify the primary procedure and document that its descriptor does not include graft procurement
Operative note must name the graft type (fascia lata, complex/sheet) and describe the harvesting technique explicitly
Document the harvest site (thigh), graft dimensions, and intended use at the recipient site
Specify that open area exposure — not a stripper — was used to differentiate 20922 from 20920
Record any closure technique applied to the harvest site

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 20922 describes open harvest of a fascia lata graft from the thigh using a formal incision with area exposure — the more involved technique compared to 20920 (stripper method). The procedure yields a complex or sheet-style graft suitable for tendon reconstruction, chest wall repair, eyelid and orbital defects, and similar applications where a larger, intact fascial segment is required.

Bill 20922 only when the graft is harvested through a separate skin/fascial incision from the primary procedure. If the primary procedure's descriptor already states 'includes obtaining graft,' 20922 is bundled and not separately reportable — this is a hard CPT guideline, not a payer quirk. The NCCI policy manual reinforces that autogenous graft codes (including 20922) are separately reportable only when the primary code does not incorporate graft procurement.

The 90-day global period means all routine post-op care for the harvest site is included through day 90. Unrelated problems billed in that window require modifier 24 (E/M) or modifier 79 (unrelated procedure in the global). A return to the OR for a complication at the harvest site that was not planned uses modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.76
Practice expense RVU	11.41
Malpractice RVU	1.51
Total RVU	19.68
Medicare national rate	$657.33
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	$657.33
HOPD (APC 5054) Hospital outpatient department	$2,107.97
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,128.57

Common denial reasons

The recurring reasons claims for CPT 20922 get rejected.

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

Primary procedure descriptor already includes graft procurement — 20922 bundles automatically and is not separately billable
Missing documentation of a separate incision at the harvest site; payers treat it as integral to the primary procedure
Operative note uses generic language like 'fascia lata graft obtained' without specifying open area exposure, triggering downcoding to 20920
Modifier 59 or XS not appended when NCCI bundles 20922 with the primary code and a modifier-bypassable edit exists
Billing for 20922 with a primary code that has a PTP edit indicator of '0' — no modifier can override those edits

Frequently asked questions

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

01What separates 20922 from 20920?

20920 uses a fascial stripper — a minimally invasive harvest technique. 20922 requires open incision and area exposure to obtain a complex or sheet graft. The distinction must be explicit in the operative note; 20920 reimburses at a lower rate.

02Can I bill 20922 when the graft is harvested through the same incision as the primary procedure?

No. CPT guidelines require a separate skin or fascial incision to report any code in the 20900–20924 series separately. Same-incision harvest is bundled into the primary procedure.

03Which primary procedures bundle 20922 and cannot be unbundled even with a modifier?

Any primary procedure whose descriptor states 'includes obtaining graft' — such as 25274 or 25431 — bundles the graft harvest regardless of incision. NCCI PTP edits with a '0' indicator also cannot be overridden by any modifier. Check the NCCI edit table for the specific code pair before billing.

04Is modifier 51 required when billing 20922 with a primary surgical procedure?

Yes, modifier 51 is appropriate on 20922 as the secondary procedure when billed same-day with a primary surgical code, unless the primary procedure is an add-on code or modifier 51 is otherwise exempt. Confirm payer requirements, as some commercial payers handle multiple-procedure reductions differently.

05What modifier applies if the surgeon has to return to the OR to address a complication at the fascia lata harvest site?

Use modifier 78 for an unplanned return to the OR for a complication related to the original harvest — for example, a hematoma evacuation at the thigh donor site during the 90-day global. Modifier 79 is for an unrelated procedure in the global period.

06Is 20922 ever separately reportable with lid retraction repair code 67911?

Yes. The CPT Professional codebook includes a specific instruction following 67911 stating that autogenous graft codes including 20922 may be reported separately. This is a named exception to the general bundling rule.

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 harvest approach (open incision with area exposure vs. stripper), graft dimensions, harvest site location, confirmation of a separate incision, and whether the primary procedure's code descriptor includes graft procurement. That documentation prevents the two most common denial triggers: bundling with a primary procedure that already includes the graft, and downcoding from 20922 to 20920 because the technique wasn't specified.

See how Mira captures CPT 20922 documentation