No office rate
Both describe microvascular bone grafting, but 20955 identifies the fibula as the donor site; this code identifies iliac bone.
On this page
CMS RVU26D · Effective 2026-10-01
20956 Bone graft Medicare reimbursement rates in Colorado
Reports transfer of vascularized bone harvested from the iliac crest with microvascular connection, commonly for reconstruction of a substantial skeletal defect. Compare 20956 office and facility rates across CMS payment localities in Colorado.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 20956 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2355.34
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Reconstructive surgery
About 20956: Microvascular iliac bone graft
Reports transfer of vascularized bone harvested from the iliac crest with microvascular connection, commonly for reconstruction of a substantial skeletal defect.
The surgeon harvests bone from the iliac crest with its blood supply and connects the graft’s vessels to recipient vessels using microsurgical technique. This vascularized bone transfer can rebuild a defect where living bone is needed, such as mandibular reconstruction after tumor removal or reconstruction of a major bone defect. Plastic, oral and maxillofacial, or orthopedic surgeons may perform the procedure in an operating room, often as part of a larger reconstruction.
Select this code when the graft is iliac bone and the procedure includes microvascular anastomosis; the donor bone site and vascular technique distinguish it from other graft codes. The operative report should identify the iliac donor site, graft transfer, vascular anastomosis, and reconstructive purpose. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 20956
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU40.15 · 57%
- Practice expense (office) RVU21.79 · 31%
- Malpractice RVU8.58 · 12%
17
Medicare services in 2024 · #5988 by national volume
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.
20956 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Use 20957 for a metatarsal donor graft. The donor bone site, not the general microvascular technique, separates it from this code.
No office rate
This code is specific to iliac bone; 20962 is the family option for a microvascular bone graft from another donor site.
No office rate
20970 describes an iliac-crest bone-and-skin graft. This code is for the microvascular iliac bone graft without that bone-and-skin distinction.
Compare 20956 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
Unavailable
Facility
$2355.34
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 20956 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
1,822
- Code
- 20956
- Physician work
- 40.15
- Practice expense
- 21.79
- Malpractice
- 8.58
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 40.15 | × 1.012 | 40.6318 |
| Practice expense | 21.79 | × 1.064 | 23.1846 |
| Malpractice | 8.58 | × 0.781 | 6.7010 |
| Total RVUs | 70.5173 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$2355.34
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 40.15 | 1.012 |
| Practice expense | 21.79 | 1.064 |
| Malpractice | 8.58 | 0.781 |
(40.15 × 1.012 + 21.79 × 1.064 + 8.58 × 0.781) × $33.4009 = $2355.34
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
20956 billing questions
How is this distinguished from other microvascular bone-graft codes?
Choose this code for a vascularized iliac bone graft. The corresponding codes for fibula, metatarsal, or another bone donor site are different members of the microvascular bone-graft family.
Is harvesting the iliac bone part of the service?
The service covers the iliac bone graft harvest and its microvascular transfer. The operative report should establish the donor site and vascular connection.
Should modifier 50 be used for grafts from both iliac crests?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not append modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does CMS handle this with other procedures in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,81920939,,Bone marrow aspir bone grfg,A,,1.13,0.37,NA,0.37,,0.34,1.84,1.84,0,ZZZ,0.00,0.00,0.00,0,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,82020950,,Mntr intrstitial fluid press,A,,1.23,6.88,,1.05,,0.22,8.33,2.50,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,82120955,,Fibula bone graft microvasc,A,,39.25,21.35,NA,21.35,,7.30,67.90,67.90,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,82220956,,Iliac bone graft microvasc,A,,40.15,21.79,NA,21.79,,8.58,70.52,70.52,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,82320957,,Mt bone graft microvasc,A,,41.54,23.14,NA,23.14,,8.86,73.54,73.54,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,82420962,,Other bone graft microvasc,A,,38.23,26.32,NA,26.32,,8.15,72.70,72.70,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,82520969,,Bone/skin graft microvasc,A,,44.29,18.42,NA,18.42,,6.82,69.53,69.53,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899