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CPT code 20938: Spinal bone graft, structural autograft, separate incision2026 Medicare rate & RVUs

Reports structural bone harvested through a separate incision and used to support a spinal fusion, in addition to the primary spine procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities836 Medicare services in 2024

Medicare pays $163.33 for 20938 nationally in a facility.

Medicare rate · 20938

Spinal bone graft, structural autograft, separate incision

Office or facility?

Work RVUs
2.94
Total RVUs
4.89
Global days
ZZZ

National rate · 2026

$163.33

Facility setting, before claim adjustments.

See every locality for 20938 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 20938 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 20938 covers

During spinal fusion, the surgeon places a structural piece of the patient’s own bone to support the fusion. The graft is harvested through a separate skin or fascial incision; an iliac crest bone block is a typical example. Orthopedic spine surgeons and neurosurgeons may use this service during cervical or lumbar fusion when structural support is needed. The graft is distinct from small local bone fragments collected through the operative exposure and from bone prepared as morselized graft.

Report 20938 only with an eligible primary spinal procedure, not as a stand-alone service. Documentation should identify the separate harvest incision, the autologous graft’s structural use, and the spinal procedure it supports. CMS treats payment for this add-on as part of the primary procedure’s global period. The code includes the graft harvest, so do not separately report another graft-harvest service for the same bone.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 20938 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

20938 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$145.28
AlaskaUnavailable$200.18
ArizonaUnavailable$157.69
ArkansasUnavailable$143.12
Atlanta, GAUnavailable$170.60
Austin, TXUnavailable$161.79
Bakersfield, CAUnavailable$155.83
Baltimore area, MDUnavailable$174.91
Beaumont, TXUnavailable$158.08
Brazoria, TXUnavailable$156.76

20938 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
20938 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 20938 rate is calculated

Each of 20938’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 20938

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.94

2.94 RVUs× 1.000 GPCI

Practice expense0.99

0.99 RVUs× 1.000 GPCI

Malpractice0.96

0.96 RVUs× 1.000 GPCI

Adjusted RVUs

4.8900

Conversion factor

$33.4009

Medicare rate

$163.33

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 20938

The CMS indicators that decide how 20938 is paid alongside other services.

CMS payment indicators · 20938

Spinal bone graft, structural autograft, separate incision

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 80 · payment effect

With and without the modifier

20938 without 80 · national facility

$163.33

Spinal bone graft, structural autograft, separate incision

20938-80 · Assistant: 16%

$26.13

A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.

When to use modifier 80

20938 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 20938

    Spinal bone graft, structural autograft, separate incision2.94 wRVU

    Not priced

  • 20937

    Spinal bone graft, morselized, separate incision2.72 wRVU

    Not priced

  • 20936

    Spinal autograft, local, same incision0 wRVU

    Not priced

  • 20931

    Spinal bone graft, structural allograft1.76 wRVU

    Not priced

How to choose

20937Spinal bone graftMorselized, separate incision
Both describe autologous bone harvested through a separate incision for spine surgery. Choose 20938 for structural bone and 20937 for morselized bone.
20936Spinal autograftLocal, same incision
Code 20936 covers local bone obtained through the same incision as the spinal procedure; 20938 is for structural autograft harvested through a separate incision.
20931Spinal bone graftStructural allograft
Code 20931 is for structural allograft. Code 20938 is for structural bone harvested from the patient.

Codes related to 20938

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 20938
CodeHow it relatesNational office range
Primary code
22612Spinal fusion, posterior lumbar, single levelA lumbar fusion procedure that may serve as the primary service for this spinal graft add-on.No office rate
22551ACDF, one cervical interspace with decompressionAn anterior cervical fusion procedure that may serve as the primary service for this graft add-on.No office rate
Same family
20937Spinal bone graft, morselized, separate incisionSpinal autograft add-on for morselized bone harvested through a separate incision.No office rate
20936Spinal autograft, local, same incisionSpinal autograft add-on for local bone obtained through the primary operative incision.No office rate
Used instead
20931Spinal bone graft, structural allograftStructural allograft for spine surgery rather than the patient’s own harvested bone.No office rate
20930Spinal graft material, morselized allograftMorselized allograft or osteopromotive material for spine surgery, rather than structural autograft.No office rate

20938 billing questions

When should 20938 be chosen instead of 20937?

Use 20938 for a structural autograft harvested through a separate incision. Code 20937 describes autologous bone prepared as morselized graft, rather than a structural bone block.

How does 20938 differ from 20936?

Code 20936 is for local autologous bone obtained through the same incision as the spinal procedure. Code 20938 involves a structural graft harvested through a separate incision.

Can 20938 be reported by itself?

No. It is an add-on code and must be reported with an eligible primary spinal procedure.

Can the harvest be billed separately?

The graft harvest is included in 20938. Document the separate incision and graft use, but do not report another harvest service for that same bone.

What documentation supports 20938?

The operative report should identify the separate harvest incision, the autologous graft’s structural form and use, and the primary spinal procedure.

How does CMS treat the global period?

CMS treats payment for 20938 as occurring within the primary procedure’s global period.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 20938PPRRVU2026_Oct_nonQPP.csv, line 1,818 (RVU26D)

Open CMS sourceHow we calculate rates

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