Summary & Overview

CPT 20962: Vascularized Bone Graft for Major Bone Defect

CPT code 20962 identifies a surgical procedure for harvesting and transplanting a vascularized bone graft from donor sites other than the fibula, iliac crest, or metatarsals to reconstruct major bone defects. This code is clinically significant because vascularized grafts carry their own arterial and venous supply, which can accelerate healing and improve graft integration in complex reconstructions. Nationally, use of this procedure reflects advanced reconstructive orthopedic and microsurgical practice for traumatic, oncologic, or large segmental bone loss.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and procedural context, payer coverage patterns and benchmarks where available, and policy or coding considerations that affect billing and reimbursement for complex vascularized bone graft procedures. The publication also highlights typical sites of service, common billing modifiers (listed separately), and where input data is missing. Content is presented to aid coding professionals, revenue-cycle managers, and clinical leaders seeking a national-level reference on CPT code 20962.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare20962CPTvascularized bone graftorthopedic surgeryreconstructive surgerymicrosurgeryoperative proceduresurgical coding

Billing Code Overview

CPT code 20962 describes a vascularized bone graft procedure in which a provider harvests bone graft material from a donor site other than the fibula, iliac crest, or metatarsal bones along with its active vascular supply (arteries and veins) and transplants it to fill a major bone defect at the recipient site. The regained vascular supply at the recipient site promotes faster healing and bone growth.

Service type: Surgical autologous vascularized bone grafting to repair major bone defects.
Typical site of service: Operating room or surgical suite in an inpatient or outpatient hospital setting, or ambulatory surgery center, depending on clinical complexity and care needs.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 48-year-old male presents with a large segmental tibial bone defect following a high-energy motorcycle collision with soft-tissue degloving and exposed bone. After initial debridement and stabilization with external fixation, the orthopedic microsurgery team plans a free vascularized bone graft harvested from the contralateral femoral condyle (or another non-iliac, non-fibula, non-metatarsal donor site) with microvascular anastomosis of the graft's artery and vein to recipient vessels at the defect site. The procedure aims to restore structural continuity and deliver a live, perfused bone segment to promote faster incorporation and healing at the recipient site. Typical workflow includes preoperative imaging (CT or MRI of the defect and donor site), multidisciplinary planning with plastic/microsurgery and orthopedics, intraoperative harvest of the vascularized bone graft, microvascular anastomosis, fixation of the graft into the defect, and postoperative monitoring in a surgical unit with flap monitoring and antibiotics. Typical site of service is an inpatient operating room within a hospital or an ambulatory surgical center with microsurgical capability for complex reconstructions. The service type is surgical: microvascular vascularized bone grafting from a non-fibula/iliac/metatarsal donor site to repair a major bone defect, consistent with code 20962.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

Taxonomy Code	Specialty	Notes
207L00000X	Orthopedic Surgery	Orthopedic surgeons perform harvest, fixation, and overall reconstruction planning.
2080P0208X	Plastic and Reconstructive Surgery	Microsurgeons handle vascular anastomosis and soft tissue coverage.
208000000X	General Surgery (Trauma)	Trauma surgeons involved in initial debridement and stabilization in emergent cases.
2087S0105X	Surgery, Hand	Hand/upper extremity surgeons may perform vascularized bone grafts for complex wrist/hand defects.
207XS0117X	Orthopedic Surgery of the Foot and Ankle	Foot/ankle specialists perform reconstructions for lower extremity bone defects.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.361A`	Stress fracture, tibia, right leg, initial encounter for fracture	Large segmental or complex tibial fractures may require vascularized bone grafting for reconstruction.
`S82.201A`	Unspecified fracture of shaft of tibia, initial encounter for closed fracture	Segmental tibial shaft defects after fracture can necessitate vascularized bone transfer to restore continuity.
`M84.371A`	Pathological fracture, tibia, left leg, initial encounter	Pathologic fractures with bone loss may be reconstructed with vascularized bone grafts.
`T79.A2XA`	Traumatic compartment syndrome of lower limb, initial encounter	Severe soft-tissue injury and bone loss associated with trauma can lead to complex reconstructions including vascularized bone grafts.
`M86.172`	Chronic osteomyelitis with draining sinus, left tibia and fibula	Chronic osteomyelitis with bone defect may be treated with vascularized bone grafting after debridement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`15738`	Muscle, myocutaneous or fasciocutaneous flap with microvascular anastomosis; free flap	May be performed concomitantly if soft-tissue free flap coverage is required in addition to the vascularized bone graft.
`20680`	Removal of implant; deep (e.g., buried hardware)	May be required before grafting if prior hardware is infected or impeding reconstruction.
`24920`	Repair, tendon, flexor or extensor; with free graft (includes obtaining graft)	Relevant when tendon grafting is performed in complex extremity reconstructions alongside bone grafting.
`49652`	Muscle or myocutaneous free flap for abdominal wall reconstruction (includes microvascular anastomosis)	Example of microvascular free tissue transfer codes that may be performed in multidisciplinary reconstructions with `20962`.
`11010`	Debridement of bone (sequestrectomy)	Often performed prior to vascularized bone grafting to remove necrotic bone and prepare the recipient site.