Billing code 20956: Bone graftMedicare rate & RVUs in Oregon
Reports transfer of vascularized bone harvested from the iliac crest with microvascular connection, commonly for reconstruction of a substantial skeletal defect.
CMS doesn’t publish an office rate for 20956 in Oregon.
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 20956 covers
The surgeon harvests bone from the iliac crest with its blood supply and connects the graft’s vessels to recipient vessels using microsurgical technique. This vascularized bone transfer can rebuild a defect where living bone is needed, such as mandibular reconstruction after tumor removal or reconstruction of a major bone defect. Plastic, oral and maxillofacial, or orthopedic surgeons may perform the procedure in an operating room, often as part of a larger reconstruction.
Select this code when the graft is iliac bone and the procedure includes microvascular anastomosis; the donor bone site and vascular technique distinguish it from other graft codes. The operative report should identify the iliac donor site, graft transfer, vascular anastomosis, and reconstructive purpose. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 20956 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $2,384.31 |
| Rest Of Oregon | Unavailable | $2,267.41 |
How the 20956 rate is calculated
Each of 20956’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 · 20956
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 40.15Practice expense 21.79Malpractice 8.58
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 20956
20956 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20956
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 · 20956
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
20956 without 51 · national facility
$2,355.43
Bone graft
20956-51 · Second procedure: 50%
$1,177.72
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%).
20956 compared with similar codes
Compare codes
20956 vs 20955 vs 20957 vs 20962 vs 20970: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 20955Bone graft
- Both describe microvascular bone grafting, but 20955 identifies the fibula as the donor site; this code identifies iliac bone.
- 20957Bone graft
- Use 20957 for a metatarsal donor graft. The donor bone site, not the general microvascular technique, separates it from this code.
- 20962Bone graft
- This code is specific to iliac bone; 20962 is the family option for a microvascular bone graft from another donor site.
- 20970Bone and skin graft
- 20970 describes an iliac-crest bone-and-skin graft. This code is for the microvascular iliac bone graft without that bone-and-skin distinction.
20956 billing questions
How is this distinguished from other microvascular bone-graft codes?
Choose this code for a vascularized iliac bone graft. The corresponding codes for fibula, metatarsal, or another bone donor site are different members of the microvascular bone-graft family.
Is harvesting the iliac bone part of the service?
The service covers the iliac bone graft harvest and its microvascular transfer. The operative report should establish the donor site and vascular connection.
Should modifier 50 be used for grafts from both iliac crests?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not append modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does CMS handle this with other procedures in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
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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