Billing code 20972: Free flapMedicare rate & RVUs in Illinois
Reports microsurgical transfer of metatarsal bone with attached skin to reconstruct a defect requiring both tissue types and vascular connection.
CMS doesn’t publish an office rate for 20972 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 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 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 | $2,946.33 |
| East St. Louis | Unavailable | $2,783.58 |
| Rest Of Illinois | Unavailable | $2,638.68 |
| Suburban Chicago | Unavailable | $2,801.58 |
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
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
| 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) | 0 | Not permitted. |
| 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 · 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.
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%).
20972 compared with similar codes
Compare codes
20972 vs 20957 vs 20970 vs 20973: national Medicare rates
Swap in your local Medicare rate.
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.
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
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