CPT Code 20956

CPT code 20956 is for a microvascular iliac bone graft procedure, used in surgeries to transfer bone tissue with its blood supply.

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What is CPT Code 20956

CPT code 20956 is used for a surgical procedure where a small piece of bone is taken from the iliac crest (part of the pelvis) and then transplanted to another part of the body using microvascular techniques. This means that the blood vessels of the bone graft are carefully connected to blood vessels at the new site to ensure the graft receives adequate blood supply and can heal properly.

Does CPT 20956 Need a Modifier?

For CPT code 20956 (Iliac bone graft microvascular), the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.

2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.

3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.

4. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.

5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.

6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs the procedure again on the same day.

7. Modifier 77 - Repeat Procedure by Another Physician: Used when a different physician performs the procedure again on the same day.

8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when the patient requires a return to the operating room for a related procedure during the postoperative period.

9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when the procedure is performed by the same physician during the postoperative period of another procedure, but is unrelated to the original procedure.

10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.

11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a minimal portion of the procedure.

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.

13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.

Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT and payer guidelines for the most current information.

CPT Code 20956 Medicare Reimbursement

Medicare reimbursement for CPT code 20956, which pertains to an iliac bone graft microvascular procedure, depends on several factors including the specific Medicare plan, the medical necessity of the procedure, and the setting in which the procedure is performed. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and performed in an outpatient setting. However, the reimbursement amount can vary based on geographic location and other variables.

As of the latest available data, the national average reimbursement rate for CPT code 20956 under Medicare is approximately $1,200. It is important to verify the exact reimbursement rate through the Medicare Physician Fee Schedule (MPFS) or consult with your Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information.

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