No office rate
This code is for a composite bone-and-skin graft. Use 20962 for a microvascular bone graft without the skin component.
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CMS RVU26D · Effective 2026-10-01
20969 Bone-skin graft Medicare reimbursement rates in New Jersey
Reports transfer of a vascularized bone-and-skin graft from a donor site without a separate named-site code for complex reconstruction. Compare 20969 office and facility rates across CMS payment localities in New Jersey.
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 20969 in New Jersey?
New Jersey has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2460.24–$2529.49
2 of 2 localities have a supported rate.
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 20969: Other-site microvascular bone-skin graft
Reports transfer of a vascularized bone-and-skin graft from a donor site without a separate named-site code for complex reconstruction.
This service covers transfer of a vascularized flap containing bone and skin, with the flap’s blood supply connected to vessels at the recipient site using microsurgical technique. It is used when reconstruction requires both structural bone and skin or soft-tissue coverage, such as rebuilding a defect after tumor removal or severe trauma. Reconstructive, oral and maxillofacial, orthopedic, or head and neck surgeons may perform the procedure in an operating room.
Select this code when the graft is a bone-and-skin flap from a donor site not represented by a named-site code in this family; the donor tissue, rather than the recipient defect, determines the choice. The operative report should identify the donor site, transferred bone and skin, recipient defect, and microvascular anastomosis. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. In a session with multiple procedures, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 20969
- 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 RVU44.29 · 64%
- Practice expense (office) RVU18.42 · 26%
- Malpractice RVU6.82 · 10%
1.2K
Medicare services in 2024 · #2853 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.
20969 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
20955 identifies a microvascular bone graft from the fibula. This code is for a bone-and-skin graft from a donor site not represented by a named-site option.
No office rate
20970 identifies a bone-and-skin graft by its iliac crest donor site. This code is used when the donor site is not covered by a named-site variant.
No office rate
20972 identifies a bone-and-skin graft from a metatarsal donor site; this code is for an otherwise unlisted donor site within the family.
Compare 20969 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.
2 of 2 payment localities
Northern Nj →
Office / nonfacility
Unavailable
Facility
$2529.49
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$2460.24
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20969 billing questions
When should this code be selected instead of a named-site bone-and-skin graft code?
Use it for a vascularized bone-and-skin flap when the donor site is not represented by a named-site code in this family. The donor site, not the recipient defect, drives the selection.
How does this differ from a microvascular bone graft code?
This code describes a composite transfer containing both bone and skin. A bone-only microvascular graft code is the closer choice when skin is not part of the transferred graft.
What operative details support reporting it?
Document the donor site, the bone and skin transferred, the reconstruction performed, and the microvascular connection to recipient vessels.
Can it be reported with other procedures performed in the same session?
Other separately reportable procedures may be subject to the standard multiple-procedure reduction: the highest-valued procedure is paid in full and others at 50%. The operative record should support each service.
Can modifier 50 be used, and may another surgeon assist?
A bilateral adjustment does not apply, so modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
1,82220956,,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
1,82620970,,Bone/skin graft iliac crest,A,,43.47,23.32,NA,23.32,,9.28,76.07,76.07,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,82720972,,Bone/skin graft metatarsal,A,,43.40,23.14,NA,23.14,,9.26,75.80,75.80,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,82820973,,Bone/skin graft great toe,A,,46.09,24.00,NA,24.00,,9.86,79.95,79.95,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00