Summary & Overview
CPT 20957: Vascularized Metatarsal Bone Graft for Major Defect
CPT code 20957 denotes a vascularized metatarsal bone graft: harvesting metatarsal bone with its arterial and venous supply and transplanting it to reconstruct a major bone defect with restoration of blood flow. This procedure supports faster incorporation and bone healing at complex recipient sites and is important in limb salvage, reconstructive orthopedic and podiatric surgery. Nationally, the code matters for hospitals, surgical specialists, and payers because it represents a technically complex, resource-intensive reconstructive service with implications for coverage policy and clinical pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will get a concise clinical definition and service context, a summary of typical sites of service, and an outline of common billing considerations. The publication provides benchmarks where available, discusses relevant coverage and policy themes, and situates the procedure within clinical practice for major bone defect reconstruction. It highlights the clinical rationale for vascularized grafting and what clinicians and billing professionals should expect when documenting and coding this procedure.
Data not available in the input: Associated taxonomies, specific ICD-10 diagnoses, related codes, and payer-specific reimbursement rates.
Billing Code Overview
CPT code 20957 describes a surgical procedure in which a provider harvests bone graft material from the metatarsal bone along with its intact vascular supply (arteries and veins) and transplants it to fill a major bone defect at a recipient site. The retained vascular supply is reestablished at the recipient site to promote faster healing and bone growth.
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Service type: Vascularized metatarsal bone grafting for reconstruction of major bone defects
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Typical site of service: Inpatient or outpatient surgical setting—commonly performed in operating rooms for reconstructive orthopedic or podiatric procedures under sterile conditions
Clinical & Coding Specifications
Clinical Context
A 52-year-old male presents with a segmental distal tibial bone loss after an open, comminuted fracture complicated by infection and nonunion. Prior internal fixation failed and the wound has been debrided; reconstruction requires vascularized bone transfer to restore structural continuity and promote rapid revascularization. The orthopedic or reconstructive microsurgeon obtains a vascularized metatarsal bone graft (including arterial and venous pedicle) to fill the major tibial defect at the recipient site. The operative workflow includes preoperative vascular and imaging assessment, harvest of the metatarsal with microsurgical dissection of its vascular pedicle, preparation of the recipient site with debridement and fixation, microvascular anastomosis of arteries and veins to recipient vessels, inset of the graft to restore length and alignment, and layered closure with postoperative monitoring of graft perfusion in a monitored inpatient setting. Typical perioperative care includes antibiotics, anticoagulation as indicated, serial neurovascular checks, and wound and flap monitoring in the immediate postoperative period. Typical sites of service are inpatient operating room or ambulatory surgery center with microsurgical capability depending on case complexity and patient comorbidity. Common clinical indications include large segmental bone defects from trauma, tumor resection, or chronic osteomyelitis requiring vascularized structural bone transfer for healing and limb salvage.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons |