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CPT code 20957: Bone graft, metatarsal, microvascular transfer2026 Medicare rate & RVUs

Reports transfer of a vascularized metatarsal bone graft with microvascular connection for reconstruction when the recipient site needs living bone tissue.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $2,456.30 for 20957 nationally in a facility.

Medicare rate · 20957

Bone graft, metatarsal, microvascular transfer

Office or facility?

Work RVUs
41.54
Total RVUs
73.54
Global days
090

National rate · 2026

$2,456.30

Facility setting, before claim adjustments.

See every locality for 20957 →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 20957 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 20957 covers

An orthopedic, plastic, or reconstructive surgeon harvests a metatarsal segment and transfers it as living bone, reconnecting its vessels to recipient-site vessels under magnification. The code is selected when reconstruction calls for a vascularized metatarsal graft rather than a nonvascularized graft or a different donor bone. Examples include complex reconstruction of a skeletal defect after trauma or resection. The operative record should identify the donor bone, recipient defect, graft transfer, and microvascular anastomosis.

This major surgery carries a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

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 20957 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

20957 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,231.26
AlaskaUnavailable$3,067.40
ArizonaUnavailable$2,389.73
ArkansasUnavailable$2,203.80
Atlanta, GAUnavailable$2,532.31
Austin, TXUnavailable$2,470.17
Bakersfield, CAUnavailable$2,441.15
Baltimore area, MDUnavailable$2,605.06
Beaumont, TXUnavailable$2,365.73
Brazoria, TXUnavailable$2,395.34

20957 rates by state

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

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Explore a state

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
20957 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 20957 rate is calculated

Each of 20957’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 · 20957

RVUs × geographic indexes × conversion factor

Office or facility?

Work41.54

41.54 RVUs× 1.000 GPCI

Practice expense23.14

23.14 RVUs× 1.000 GPCI

Malpractice8.86

8.86 RVUs× 1.000 GPCI

Adjusted RVUs

73.5400

Conversion factor

$33.4009

Medicare rate

$2,456.30

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

Payment rules and modifiers for 20957

20957 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 20957

Bone graft, metatarsal, microvascular transfer

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 20957

Bone graft, metatarsal, microvascular transfer

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

20957 without 51 · national facility

$2,456.30

Bone graft, metatarsal, microvascular transfer

20957-51 · Second procedure: 50%

$1,228.15

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

20957 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 20957

    Bone graft, metatarsal, microvascular transfer41.54 wRVU

    Not priced

  • 20955

    Bone graft, fibula, microvascular39.25 wRVU

    Not priced

  • 20956

    Bone graft, iliac, microvascular40.15 wRVU

    Not priced

  • 20962

    Bone graft, other donor site38.23 wRVU

    Not priced

  • 20972

    Free flap, metatarsal bone and skin43.4 wRVU

    Not priced

How to choose

20955Bone graftFibula, microvascular
Use 20955 when the vascularized bone graft comes from the fibula; 20957 identifies a metatarsal donor graft.
20956Bone graftIliac, microvascular
Use 20956 for a vascularized iliac bone graft. The donor bone for 20957 is the metatarsal.
20962Bone graftOther donor site
20962 is the category for a vascularized bone graft from another donor bone; 20957 specifically identifies a metatarsal graft.
20972Free flapMetatarsal bone and skin
20972 describes a vascularized metatarsal bone-and-skin graft; 20957 is for the metatarsal bone graft without that skin component.

Codes related to 20957

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

Codes related to 20957
CodeHow it relatesNational office range
Same family
20955Bone graft, fibula, microvascularMicrovascular bone graft using a fibula donor site.No office rate
20956Bone graft, iliac, microvascularMicrovascular bone graft using an iliac bone donor site.No office rate
20962Bone graft, other donor siteMicrovascular bone graft using a donor bone other than the specifically listed sites.No office rate
Used instead
20972Free flap, metatarsal bone and skinMetatarsal graft code for a vascularized bone-and-skin transfer.No office rate

20957 billing questions

How is this code distinguished from the other microvascular bone-graft codes?

This code identifies a metatarsal donor graft. Codes 20955, 20956, and 20962 identify fibula, iliac bone, and other bone grafts, respectively.

When would code 20972 be considered instead?

Code 20972 describes a vascularized metatarsal bone-and-skin graft. Use 20957 for a metatarsal bone graft without the skin component described by that code.

What operative documentation supports reporting this code?

Document the metatarsal donor site, the recipient defect, transfer of the vascularized bone, and the microvascular anastomosis.

How does the 90-day global period affect postoperative reporting?

The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period.

Can modifiers 50, assistant, or co-surgeon reporting be used?

Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, while team surgery is not permitted.

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 20957PPRRVU2026_Oct_nonQPP.csv, line 1,823 (RVU26D)

Open CMS sourceHow we calculate rates

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