CPT code 20957: Bone graft2026 Medicare rate & RVUs in Illinois
Reports transfer of a vascularized metatarsal bone graft with microvascular connection for reconstruction when the recipient site needs living bone tissue.
CMS doesn’t publish an office rate for 20957 in Illinois.
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 20957 covers
An orthopedic, plastic, or reconstructive surgeon harvests a metatarsal segment and transfers it as living bone, reconnecting its vessels to recipient-site vessels under magnification. The code is selected when reconstruction calls for a vascularized metatarsal graft rather than a nonvascularized graft or a different donor bone. Examples include complex reconstruction of a skeletal defect after trauma or resection. The operative record should identify the donor bone, recipient defect, graft transfer, and microvascular anastomosis.
This major surgery carries a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made; 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 20957 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $2,853.11 |
| East St. Louis | Unavailable | $2,694.55 |
| Rest Of Illinois | Unavailable | $2,555.67 |
| Suburban Chicago | Unavailable | $2,715.34 |
How the 20957 rate is calculated
Each of 20957’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 · 20957
RVUs × geographic indexes × conversion factor
Work41.54
41.54 RVUs× 1.000 GPCI
Practice expense23.14
23.14 RVUs× 1.000 GPCI
Malpractice8.86
8.86 RVUs× 1.000 GPCI
Adjusted RVUs
73.5400
Conversion factor
$33.4009
Medicare rate
$2,456.30
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20957
20957 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20957
Bone graft
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 20957
Bone 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
20957 without 51 · national facility
$2,456.30
Bone graft
20957-51 · Second procedure: 50%
$1,228.15
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%).
20957 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 20955Bone graft
- Use 20955 when the vascularized bone graft comes from the fibula; 20957 identifies a metatarsal donor graft.
- 20956Bone graft
- Use 20956 for a vascularized iliac bone graft. The donor bone for 20957 is the metatarsal.
- 20962Bone graft
- 20962 is the category for a vascularized bone graft from another donor bone; 20957 specifically identifies a metatarsal graft.
- 20972Free flap
- 20972 describes a vascularized metatarsal bone-and-skin graft; 20957 is for the metatarsal bone graft without that skin component.
20957 billing questions
How is this code distinguished from the other microvascular bone-graft codes?
This code identifies a metatarsal donor graft. Codes 20955, 20956, and 20962 identify fibula, iliac bone, and other bone grafts, respectively.
When would code 20972 be considered instead?
Code 20972 describes a vascularized metatarsal bone-and-skin graft. Use 20957 for a metatarsal bone graft without the skin component described by that code.
What operative documentation supports reporting this code?
Document the metatarsal donor site, the recipient defect, transfer of the vascularized bone, and the microvascular anastomosis.
How does the 90-day global period affect postoperative reporting?
The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period.
Can modifiers 50, assistant, or co-surgeon reporting be used?
Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, while team surgery is not permitted.
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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