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Billing code 20972: Free flapMedicare rate & RVUs

Reports microsurgical transfer of metatarsal bone with attached skin to reconstruct a defect requiring both tissue types and vascular connection.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $2,531.79 for 20972 nationally in a facility.

Medicare rate · 20972

Free flap

Swap in your local Medicare rate.

Work RVUs
43.4
Total RVUs
75.80
Global days
090

National rate · 2026

$2,531.79

Facility setting, before claim adjustments.

See every locality for 20972 → · 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 20972 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 20972 covers

A reconstructive surgeon harvests metatarsal bone with an attached skin paddle, transfers the tissue to a recipient defect, and reconnects its blood supply using microsurgical anastomosis. The flap can restore a defect that requires both bone and skin, such as one resulting from tumor removal or trauma. This is generally performed in a hospital operating room by a plastic, orthopedic, or oral and maxillofacial surgeon, depending on the defect and reconstructive plan.

Report the metatarsal flap when the operative record supports transfer of both bone and skin with microvascular connection; the code includes obtaining the graft. Documentation should identify the donor tissue, recipient defect, and flap transfer. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be allowed; co-surgeons and team surgery are 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 20972 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

20972 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,300.94
Alaska*Unavailable$3,167.95
ArizonaUnavailable$2,463.29
ArkansasUnavailable$2,272.80
AtlantaUnavailable$2,610.67
AustinUnavailable$2,544.26
BakersfieldUnavailable$2,512.60
Baltimore/Surr. CntysUnavailable$2,684.71
BeaumontUnavailable$2,440.27
BrazoriaUnavailable$2,468.38

20972 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.

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20972 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 20972 rate is calculated

Each of 20972’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 · 20972

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 43.40Practice expense 23.14Malpractice 9.26

75.8000 adjusted RVUs×$33.4009 conversion factor=$2,531.79

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

Payment rules and modifiers for 20972

20972 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 20972

Free flap

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)0Not permitted.
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 · 20972

Free flap

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

20972 without 51 · national facility

$2,531.79

Free flap

20972-51 · Second procedure: 50%

$1,265.90

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

20972 compared with similar codes

Compare codes

20972 vs 20957 vs 20970 vs 20973: national Medicare rates

Swap in your local Medicare rate.

  • 20972
    Free flap · 43.4 wRVU
    —
  • 20957
    Bone graft · 41.54 wRVU
    —
  • 20970
    Bone and skin graft · 43.47 wRVU
    —
  • 20973
    Bone/skin graft · 46.09 wRVU
    —

How to choose

20957Bone graft
20972 represents a metatarsal flap with bone and skin. 20957 is the metatarsal free bone-graft code when skin is not transferred as part of the flap.
20970Bone and skin graft
Both represent free osteocutaneous flap reconstruction with microvascular connection; 20970 identifies iliac crest as the donor source, while 20972 identifies metatarsal.
20973Bone/skin graft
Both are osteocutaneous flap codes, but 20973 uses great toe donor tissue rather than metatarsal.

Codes related to 20972

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

Codes related to 20972
CodeHow it relatesNational office range
Used instead
20957Bone graftMetatarsal free bone transfer when the flap does not include a skin component.No office rate
20955Bone graftFree fibula bone graft with microvascular connection when fibula is the selected donor source.No office rate
Same family
20970Bone and skin graftOsteocutaneous flap using iliac crest rather than metatarsal donor tissue.No office rate
20973Bone/skin graftOsteocutaneous flap using great toe donor tissue.No office rate
20969Bone-skin graftOsteocutaneous flap from another donor source in the same code family.No office rate

20972 billing questions

When should this be chosen instead of a metatarsal bone-only flap?

Use this code when the transferred metatarsal tissue includes skin as well as bone and is connected by microsurgical anastomosis. A bone-only metatarsal transfer is represented by 20957.

Does the code include harvesting the graft?

Yes. The code includes obtaining the metatarsal bone and skin used for the flap.

What operative details support reporting this code?

Document the metatarsal donor tissue, the included skin paddle, the recipient defect, and the microsurgical vascular connection.

Can modifier 50 be used when both sides are treated?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.

How does the global period affect postoperative reporting?

The 90-day global includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.

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 20972PPRRVU2026_Oct_nonQPP.csv, line 1,827 (RVU26D)

Open CMS sourceHow we calculate rates

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