Billing code 20969: Bone-skin graftMedicare rate & RVUs in Virginia
Reports transfer of a vascularized bone-and-skin graft from a donor site without a separate named-site code for complex reconstruction.
CMS doesn’t publish an office rate for 20969 in Virginia.
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 20969 covers
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.
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 20969 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $2,537.50 |
| Virginia | Unavailable | $2,244.93 |
How the 20969 rate is calculated
Each of 20969’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 · 20969
RVUs × geographic indexes × conversion factor
Work44.29
44.29 RVUs× 1.000 GPCI
Practice expense18.42
18.42 RVUs× 1.000 GPCI
Malpractice6.82
6.82 RVUs× 1.000 GPCI
Adjusted RVUs
69.5300
Conversion factor
$33.4009
Medicare rate
$2,322.36
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20969
20969 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20969
Bone-skin 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 · 20969
Bone-skin 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
20969 without 51 · national facility
$2,322.36
Bone-skin graft
20969-51 · Second procedure: 50%
$1,161.18
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%).
20969 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 20962Bone graft
- This code is for a composite bone-and-skin graft. Use 20962 for a microvascular bone graft without the skin component.
- 20955Bone graft
- 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.
- 20970Bone and skin graft
- 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.
- 20972Free flap
- 20972 identifies a bone-and-skin graft from a metatarsal donor site; this code is for an otherwise unlisted donor site within the family.
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 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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