Spine Bone Graft Coding and Reimbursement
This policy governs reimbursement for specific spine graft procedure codes (allograft, autograft, bone marrow aspiration) for SelectHealth Commercial, SelectHealth Advantage (Medicare), and Select Health Community Care (Medicaid/CHIP) members.
No material clinical or coverage changes in this revision.
Coverage criteria for spine graft add-on codes
Coverage criteria for spine graft add-on codes
Plan-specific reimbursement positions for listed CPT codes used in spine grafting procedures.
DENY
ALLOW WITH LIMIT
- Code 20931 (Allograft, structural, for spine surgery only) may be reimbursed when billed in addition to a primary procedure; limit: one unit of this code per operative session regardless of number of vertebral levels fused.
- Code 20937 (Autograft for spine surgery only; morselized, through separate incision) may be reimbursed when billed in addition to a primary procedure; limit: one unit of this code per operative session regardless of number of vertebral levels fused.
- Code 20938 (Autograft, structural, bicortical or tricortical, through separate incision) may be reimbursed when billed in addition to a primary procedure; limit: one unit of this code per operative session regardless of number of vertebral levels fused.
- Code 20939 (Bone marrow aspiration for bone grafting, spine surgery only, through separate incision) may be reimbursed when billed in addition to a primary procedure; limit: one unit of this code per operative session regardless of number of vertebral levels fused.
Spine graft add-on codes and unit limits
| 20930 | Allograft, morselized, or placement of osteopromotive material, for spine surgery only |
| 20931 | Allograft, structural, for spine surgery only |
| 20936 | Autograft for spine surgery only; local (includes harvesting the graft) obtained from same incision (eg, ribs, spinous process, or laminar fragments) |
| 20937 | Autograft for spine surgery only; morselized (includes harvesting the graft) through separate skin or fascial incision |
| 20938 | Autograft for spine surgery only; structural, bicortical or tricortical (includes harvesting the graft) through separate skin or fascial incision |
| 20939 | Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision |
Billing and reimbursement actions for spine graft add-on codes
Billing and reimbursement actions for spine graft add‑on codes
Do not bill CPT codes 20930 and 20936 for reimbursement; CPT codes 20931, 20937, 20938, and 20939 may be reimbursed but only one unit of each code is allowed per operative session. All listed codes are add-on codes and must be reported in addition to the primary procedure.
- Codes 20930 and 20936 are not reimbursed (CMS 'B' status/bundled).
- Codes 20931, 20937, 20938, and 20939 may be reimbursed with a limit of one unit per code per operative session regardless of number of vertebral levels fused.
- These CPT codes are add-on codes and must be billed in addition to the primary procedure.
Definitions
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