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Billing code 20838: Foot replantationMedicare rate & RVUs

Reports surgical reattachment of a completely separated foot after traumatic amputation, with the operative service directed at restoring the foot’s continuity.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $2,494.05 for 20838 nationally in a facility.

Medicare rate · 20838

Foot replantation

Swap in your local Medicare rate.

Work RVUs
41.81
Total RVUs
74.67
Global days
090

National rate · 2026

$2,494.05

Facility setting, before claim adjustments.

See every locality for 20838 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 20838 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 20838 covers

This service covers reattachment of a foot that has been completely separated, most often after a severe traumatic injury. It is performed in the operating room by a surgeon with replantation experience, commonly an orthopedic or plastic surgeon with microsurgical expertise. The operation may involve restoring the foot’s structural and soft-tissue continuity and blood supply so the replanted part can be assessed for viability.

Select this code when the entire foot was detached and the surgeon performs replantation; document the injury, the anatomical level, complete separation, and the reattachment performed. It has a 90-day global period, including the day-before preoperative visit and related postoperative care for 90 days. In a same-session group of procedures, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 identifies bilateral surgery, which is paid at 150%. An assistant at surgery may be paid; co-surgeons require 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 20838 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

20838 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,264.69
Alaska*Unavailable$3,110.32
ArizonaUnavailable$2,426.32
ArkansasUnavailable$2,236.69
AtlantaUnavailable$2,570.98
AustinUnavailable$2,509.19
BakersfieldUnavailable$2,480.69
Baltimore/Surr. CntysUnavailable$2,645.43
BeaumontUnavailable$2,400.93
BrazoriaUnavailable$2,432.40

20838 rates by state

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

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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
20838 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 20838 rate is calculated

Each of 20838’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 · 20838

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 41.81Practice expense 23.93Malpractice 8.93

74.6700 adjusted RVUs×$33.4009 conversion factor=$2,494.05

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 20838

20838 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 20838

Foot replantation

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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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 · 20838

Foot replantation

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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 50 · payment effect

With and without the modifier

20838 without 50 · national facility

$2,494.05

Foot replantation

20838-50 · Bilateral: 150%

$3,741.08

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

20838 compared with similar codes

Compare codes

20838 vs 20802 vs 20805 vs 20808 vs 20816: national Medicare rates

Swap in your local Medicare rate.

  • 20838
    Foot replantation · 41.81 wRVU
    —
  • 20802
    Arm replantation · 41.55 wRVU
    —
  • 20805
    Forearm replantation · 50.17 wRVU
    —
  • 20808
    Hand replantation · 61.51 wRVU
    —
  • 20816
    Digit replantation · 31.15 wRVU
    —

How to choose

20802Arm replantation
This code is for replanting a completely separated arm. Choose 20838 when the replanted part is the foot.
20805Forearm replantation
This code addresses replantation at the forearm; 20838 describes replantation of a completely separated foot.
20808Hand replantation
This code is for a completely separated hand. The anatomical part being replanted, not the presence of microsurgical work, distinguishes it from 20838.
20816Digit replantation
This code concerns replantation of a digit, not the entire foot. Select by the part that was detached and replanted.

Codes related to 20838

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

Codes related to 20838
CodeHow it relatesNational office range
Used instead
20802Arm replantationReplantation code for a completely separated arm rather than a foot.No office rate
20805Forearm replantationReplantation code for a completely separated forearm rather than a foot.No office rate
20808Hand replantationReplantation code for a completely separated hand rather than a foot.No office rate
20816Digit replantationReplantation code for a digit rather than the entire foot.No office rate
20824Thumb replantationReplantation code for a thumb rather than a foot.No office rate

20838 billing questions

How do I distinguish this code from a hand or digit replantation code?

Use this code when the completely separated part being replanted is the foot. Codes for the hand, thumb, or a digit describe replantation at those different anatomical sites.

What documentation supports complete foot replantation?

Document the traumatic amputation, the level of separation, that the foot was completely detached, and the surgeon’s reattachment work.

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

The global period includes the day-before preoperative visit and 90 days of related postoperative care.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures performed in that session are paid at 50%.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.

How is bilateral replantation reported under the CMS facts?

Modifier 50 identifies a bilateral procedure, which is paid at 150%.

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 20838PPRRVU2026_Oct_nonQPP.csv, line 1,803 (RVU26D)

Open CMS sourceHow we calculate rates

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