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Billing code 20970: Bone and skin graftMedicare rate & RVUs

Reports transfer of vascularized iliac crest bone with a skin component and microvascular connection, commonly for complex mandibular or other skeletal reconstruction.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $2,540.81 for 20970 nationally in a facility.

Medicare rate · 20970

Bone and skin graft

Swap in your local Medicare rate.

Work RVUs
43.47
Total RVUs
76.07
Global days
090

National rate · 2026

$2,540.81

Facility setting, before claim adjustments.

See every locality for 20970 → · 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 20970 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 20970 covers

This code describes transfer of a vascularized graft containing iliac crest bone and skin, with microsurgical connection of its blood supply at the recipient site. It is used when reconstruction requires both a living bone segment and a skin paddle, such as rebuilding a mandibular defect after tumor removal or major trauma. The reconstructive surgeon harvests and transfers the graft; the work includes obtaining the graft and its microvascular transfer.

Select this code when the graft comes from the iliac crest and includes both bone and skin with microvascular anastomosis; a vascularized bone-only graft or a graft from another listed donor site points to a different code. The operative report should identify the donor site, bone and skin components, recipient defect, and microvascular work. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid; 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 20970 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

20970 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,308.92
Alaska*Unavailable$3,178.23
ArizonaUnavailable$2,472.03
ArkansasUnavailable$2,280.65
AtlantaUnavailable$2,619.93
AustinUnavailable$2,553.55
BakersfieldUnavailable$2,521.97
Baltimore/Surr. CntysUnavailable$2,694.36
BeaumontUnavailable$2,448.70
BrazoriaUnavailable$2,477.22

20970 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
20970 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 20970 rate is calculated

Each of 20970’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 · 20970

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 43.47Practice expense 23.32Malpractice 9.28

76.0700 adjusted RVUs×$33.4009 conversion factor=$2,540.81

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

Payment rules and modifiers for 20970

20970 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 20970

Bone and skin graft

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 · 20970

Bone and skin graft

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 51 · payment effect

With and without the modifier

20970 without 51 · national facility

$2,540.81

Bone and skin graft

20970-51 · Second procedure: 50%

$1,270.41

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

20970 compared with similar codes

Compare codes

20970 vs 20956 vs 20969 vs 20972: national Medicare rates

Swap in your local Medicare rate.

  • 20970
    Bone and skin graft · 43.47 wRVU
    —
  • 20956
    Bone graft · 40.15 wRVU
    —
  • 20969
    Bone-skin graft · 44.29 wRVU
    —
  • 20972
    Free flap · 43.4 wRVU
    —

How to choose

20956Bone graft
Use 20970 when the vascularized iliac crest graft includes skin as well as bone. Use 20956 for the iliac crest bone graft without a skin component.
20969Bone-skin graft
Both describe vascularized grafts containing bone and skin, but 20970 specifies the iliac crest donor site; 20969 is the other-site option.
20972Free flap
Both describe vascularized bone-and-skin grafts, but 20972 specifies a metatarsal donor site rather than the iliac crest.

Codes related to 20970

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

Codes related to 20970
CodeHow it relatesNational office range
Same family
20956Bone graftVascularized iliac crest bone graft without the skin component.No office rate
20969Bone-skin graftVascularized bone-and-skin graft from another donor site.No office rate
20972Free flapVascularized bone-and-skin graft using the metatarsal donor site.No office rate
20973Bone/skin graftVascularized bone-and-skin graft using the great toe donor site.No office rate
Used instead
20955Bone graftVascularized fibula bone graft when reconstruction uses bone without a skin component.No office rate

20970 billing questions

How is this different from 20956?

20970 describes a vascularized iliac crest graft that includes skin. 20956 is the iliac crest option when the graft is bone without a skin component.

Is graft harvest separately reported?

Obtaining the iliac crest graft is included in this service. The operative documentation should show the donor site and the transferred bone and skin components.

What should the operative report document?

Identify the iliac crest as the donor site, the skin component, the recipient defect, and the microvascular transfer. Those details distinguish this service from bone-only or other-site graft codes.

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

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

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What happens when this is performed with other procedures?

Under the standard multiple procedure rule, the highest-valued procedure is paid in full and other procedures in the same session are paid at 50%.

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 20970PPRRVU2026_Oct_nonQPP.csv, line 1,826 (RVU26D)

Open CMS sourceHow we calculate rates

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