2025 CPT code 20936
(Active) Effective Date: N/A Revision Date: N/A Surgery - General Grafts (or Implants) Procedures Musculoskeletal System Feed
Autograft for spine surgery; local (e.g., ribs, spinous process, or laminar fragments) obtained from the same incision.Reported in addition to the primary procedure code.
Modifiers 53 (discontinued procedure) or 76 (repeat procedure) might be applicable under specific circumstances.Other modifiers are generally not indicated.
Medical necessity is established by the indication for the primary spinal procedure. The bone graft is a necessary component to achieve a successful fusion.
The surgeon is responsible for harvesting the autograft, preparing the graft site, and placing the graft during the spinal procedure.This includes making the incision and extracting the graft.
In simple words: This code describes a specific part of spinal surgery where the doctor uses the patient's own bone to fill in any missing bone.The bone is taken from the same area as the main surgery.This code is added to the bill along with the main surgery code.
This CPT code, 20936, represents the harvesting and application of an autologous bone graft during spinal surgery. The graft material is obtained locally, from the same incision used for the primary spinal procedure (e.g., rib, spinous process, or lamina fragments).The code is reported as an add-on code, meaning it is used in conjunction with a primary spinal procedure code. It does *not* include the primary spinal procedure itself.The harvesting of the graft is included within this code.
Example 1: A patient undergoes an anterior cervical discectomy and fusion (ACDF). During the procedure, the surgeon harvests a rib autograft from the same incision to fill bone defects., A posterior lumbar interbody fusion (PLIF) is performed.The surgeon utilizes laminar fragments from the same incision to supplement bone graft material for the fusion., A patient undergoes a posterior spinal fusion. Bone graft material is harvested from the spinous processes during the same surgical procedure.
Detailed operative report including the location of the autograft harvest site, the amount of bone harvested, and its placement during the spinal fusion.Preoperative and postoperative imaging are also required.
** While this code is reported, it often results in non-payment from Medicare and some other payers due to bundling policies.Careful documentation and coding practices are critical.
- Revenue Code: P3D (MAJOR PROCEDURE, ORTHOPEDIC - OTHER)
- RVU: RVUs are zero for Medicare; this means Medicare does not pay for this code separately but bundles it into the primary procedure payment.
- Global Days: The global period is determined by the primary procedure code.This add-on code does not have an independent global period.
- Payment Status: Bundled by Medicare; payment is included within the primary spinal procedure code.
- Modifier TC rule: Not applicable. This is a surgical procedure, and a technical component modifier is not relevant.
- Fee Schedule: Medicare has historically assigned zero RVUs to this code, reflecting their policy of bundling this procedure into the primary spinal surgery payment.Check specific payer's fee schedules for historical information.
- Specialties:Orthopedic Surgery, Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center