No office rate
Both describe autologous bone harvested through a separate incision for spine surgery. Choose 20938 for structural bone and 20937 for morselized bone.
On this page
CMS RVU26D · Effective 2026-10-01
20938 Spinal bone graft Medicare reimbursement rates in Delaware
Reports structural bone harvested through a separate incision and used to support a spinal fusion, in addition to the primary spine procedure. Compare 20938 office and facility rates across CMS payment localities in Delaware.
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 20938 in Delaware?
Delaware 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
$160.19
1 of 1 localities have a supported rate.
Payment area: Delaware
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.
Spinal surgery
About 20938: Structural autologous bone graft for spine
Reports structural bone harvested through a separate incision and used to support a spinal fusion, in addition to the primary spine procedure.
During spinal fusion, the surgeon places a structural piece of the patient’s own bone to support the fusion. The graft is harvested through a separate skin or fascial incision; an iliac crest bone block is a typical example. Orthopedic spine surgeons and neurosurgeons may use this service during cervical or lumbar fusion when structural support is needed. The graft is distinct from small local bone fragments collected through the operative exposure and from bone prepared as morselized graft.
Report 20938 only with an eligible primary spinal procedure, not as a stand-alone service. Documentation should identify the separate harvest incision, the autologous graft’s structural use, and the spinal procedure it supports. CMS treats payment for this add-on as part of the primary procedure’s global period. The code includes the graft harvest, so do not separately report another graft-harvest service for the same bone.
CMS billing rules for 20938
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU2.94 · 60%
- Practice expense (office) RVU0.99 · 20%
- Malpractice RVU0.96 · 20%
836
Medicare services in 2024 · #3108 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.
20938 compared with similar codes
Office rates for Delaware, from the same CMS release.
20936
No office rateSp bone agrft local add-on
Code 20936 covers local bone obtained through the same incision as the spinal procedure; 20938 is for structural autograft harvested through a separate incision.
No office rate
Code 20931 is for structural allograft. Code 20938 is for structural bone harvested from the patient.
Compare 20938 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
Delaware →
Office / nonfacility
Unavailable
Facility
$160.19
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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 20938 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
1,818
- Code
- 20938
- Physician work
- 2.94
- Practice expense
- 0.99
- Malpractice
- 0.96
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.94 | × 1.005 | 2.9547 |
| Practice expense | 0.99 | × 0.988 | 0.9781 |
| Malpractice | 0.96 | × 0.899 | 0.8630 |
| Total RVUs | 4.7959 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$160.19
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.94 | 1.005 |
| Practice expense | 0.99 | 0.988 |
| Malpractice | 0.96 | 0.899 |
(2.94 × 1.005 + 0.99 × 0.988 + 0.96 × 0.899) × $33.4009 = $160.19
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.
20938 billing questions
When should 20938 be chosen instead of 20937?
Use 20938 for a structural autograft harvested through a separate incision. Code 20937 describes autologous bone prepared as morselized graft, rather than a structural bone block.
How does 20938 differ from 20936?
Code 20936 is for local autologous bone obtained through the same incision as the spinal procedure. Code 20938 involves a structural graft harvested through a separate incision.
Can 20938 be reported by itself?
No. It is an add-on code and must be reported with an eligible primary spinal procedure.
Can the harvest be billed separately?
The graft harvest is included in 20938. Document the separate incision and graft use, but do not report another harvest service for that same bone.
What documentation supports 20938?
The operative report should identify the separate harvest incision, the autologous graft’s structural form and use, and the primary spinal procedure.
How does CMS treat the global period?
CMS treats payment for 20938 as occurring within the primary procedure’s global period.
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.
1,81520934,,Intercalary algrft compl,A,,12.68,4.04,NA,4.04,,2.70,19.42,19.42,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,81620936,,Sp bone agrft local add-on,B,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,81720937,,Sp bone agrft morsel add-on,A,,2.72,0.90,NA,0.90,,0.79,4.41,4.41,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,81820938,,Sp bone agrft struct add-on,A,,2.94,0.99,NA,0.99,,0.96,4.89,4.89,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503