20924

Surgical harvest of a tendon from a distant anatomical site — such as the palmaris longus, plantaris, or toe extensor — for use as a graft in reconstruction elsewhere.

Verified May 8, 2026 · 5 sources ↓

Medicare: $469.95
Total RVUs: 14.07
Global, days: 90
Region: General

Drawn from CMSAAPCAbos

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify the donor tendon by name (e.g., palmaris longus, plantaris, extensor digitorum longus)
Document the anatomical harvest site and confirm it is distinct from the primary repair site
Record laterality of the harvest site — ipsilateral vs. contralateral to the primary procedure
Note that graft harvest was not described by or included in the primary procedure code's descriptor
Document medical necessity for the specific tendon chosen as graft material
Confirm operative note describes a separate incision or approach for graft procurement

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 20924 covers the harvest of a tendon from a location anatomically remote from the primary repair site. Common donor tendons include the palmaris longus, plantaris, and toe extensors. The code carries a 90-day global period, so the harvest and all routine post-op care are bundled into a single payment. Any unrelated procedure billed within that window requires modifier 79; a related return to the OR requires modifier 78.

The most critical bundling rule: if the graft harvest is from the same operative site or is explicitly included in the descriptor of the primary procedure code, 20924 is not separately billable. Per AAOS Global Service Data and NCCI policy, graft harvesting is bundled into codes like 27407 (cruciate repair) when performed ipsilaterally. However, if the surgeon harvests the tendon from the contralateral limb — for example, the opposite knee — most payers will reimburse 20924 alongside the primary repair code. Document the harvest site explicitly and use modifier 59 to distinguish the service when NCCI edits fire.

This code appears on the ABOS Acceptable CPT list for Orthopaedic Sports Medicine case logs, confirming its routine use in ligament and tendon reconstruction contexts. NCCI policy (Chapter IV) reinforces that graft codes in the 20900–20924 range are not separately reportable when the primary procedure's descriptor already includes graft procurement.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.51
Practice expense RVU	6.33
Malpractice RVU	1.23
Total RVU	14.07
Medicare national rate	$469.95
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	$469.95
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 20924 get rejected.

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

Graft harvest bundled into primary procedure code when performed ipsilaterally (NCCI edit)
Primary procedure descriptor already includes graft procurement, making 20924 redundant
Missing documentation of a distinct harvest site separate from the primary repair site
Modifier 59 absent when needed to bypass NCCI PTP edit on contralateral harvest
Operative note does not name the donor tendon or confirm a remote harvest site

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill 20924 with 27407 for an ACL repair using a gracilis graft from the same knee?

No. AAOS Global Service Data bundles graft harvesting into 27407 when performed ipsilaterally. 20924 is not separately billable in that scenario.

02What if the surgeon harvests the graft from the contralateral knee?

Most payers will reimburse both 27407 and 20924 when the harvest is from the opposite limb. Append modifier 59 to 20924 and document the contralateral harvest site clearly in the operative note.

03Which modifier do I use if the patient returns to the OR during the global period for a related tendon issue?

Use modifier 78 for an unplanned return to the OR for a procedure related to the original surgery. Use modifier 79 if the return procedure is unrelated to the index graft harvest.

04Does 20924 have a 90-day global period?

Yes. The 90-day global covers the harvest procedure itself and all routine post-op visits through day 90. Bill unrelated E&M services within that window with modifier 24.

05Is modifier 50 appropriate for 20924?

Only if tendons are harvested bilaterally in the same session, which is uncommon. Confirm bilateral harvest is documented and medically necessary before appending modifier 50.

06How does NCCI policy treat 20924 when the primary procedure includes graft procurement in its descriptor?

Per CMS NCCI policy (Chapter IV), codes in the 20900–20924 range are not separately reportable when the primary procedure's descriptor already includes tissue transfer or graft procurement. Review the primary code descriptor before billing 20924.

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 tendon name, harvest site anatomy, laterality, and confirmation that a separate incision was made distinct from the primary repair. It flags cases where the primary procedure code's descriptor may already include graft harvest, prompting the coder to verify before billing 20924 separately. This prevents the most common denial: NCCI bundling when harvest laterality or site separation isn't documented.

See how Mira captures CPT 20924 documentation