Billing code 20838: Foot replantationMedicare rate & RVUs in Guam
Reports surgical reattachment of a completely separated foot after traumatic amputation, with the operative service directed at restoring the foot’s continuity.
CMS doesn’t publish an office rate for 20838 in Guam.
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 9 sections
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.
20838 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $2,477.98 |
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
Work41.81
41.81 RVUs× 1.000 GPCI
Practice expense23.93
23.93 RVUs× 1.000 GPCI
Malpractice8.93
8.93 RVUs× 1.000 GPCI
Adjusted RVUs
74.6700
Conversion factor
$33.4009
Medicare rate
$2,494.05
Every GPCI starts 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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share 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.
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).
20838 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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