ICD-10 Code M45.6: Ankylosing spondylitis lumbar region
ICD-10 Code M45.6 is the billable ICD-10-CM diagnosis code for ankylosing spondy...
Last Updated: August 3, 2026
Key takeaways
CPT code 20150 covers excision of an epiphyseal bar, with or without an autogenous soft tissue graft taken through the same fascial incision.
That same-incision graft is bundled into the code, so a separate graft harvest code is an unbundling error.
The code carries a 90-day global surgery period, which bundles routine pre-operative and post-operative visits into the surgical payment.
Medicare rates, RVU values, and ASC payment indicators change every year, so check the current CMS figures before you bill.
Practice management software like Pabau helps orthopedic practices apply the right modifiers and catch bundling errors before claims go out.
CPT code 20150 covers excision of an epiphyseal bar, with or without an autogenous soft tissue graft obtained through the same fascial incision. An epiphyseal bar is a bony bridge across a growth plate, and removing it is what this code pays for. The AMA maintains the descriptor as part of the CPT code set.
The code sits in the Musculoskeletal System section, under General Excision Procedures, which runs from 20150 to 20251. This guide covers the modifiers, Medicare payment, RVU components, ASC status, documentation, and lookalike codes for 20150.
One phrase in the descriptor does most of the work. The graft is bundled because it is “obtained through same fascial incision.” That makes the incision itself something the operative note has to record.
Procedure overview: What an epiphyseal bar excision involves
An epiphyseal bar is a bony bridge that forms across a growth plate after a fracture, an infection, or another injury to the physis. Left untreated, it tethers growth and causes progressive angular deformity.
That deformity is what later shows up as secondary joint disease under codes like M17.5. Excision is the primary intervention to restore growth plate function.
CPT code 20150 is typically performed in pediatric patients undergoing growth plate correction. The surgeon resects the physeal bar under direct visualization, often with fluoroscopic guidance. Fat or autogenous soft tissue is then interposed to stop the bar reforming.
Because the descriptor covers a graft taken through the same fascial incision, that harvest is not separately billable.
- Patient population: Primarily pediatric patients with post-traumatic or post-infectious physeal bar formation
- Setting: Hospital operating room or ambulatory surgery center (see ASC section below)
- Graft inclusion: A soft tissue graft taken through the same incision is bundled, so no separate harvest code applies
- Approach: Open surgical excision, typically using Langenskiold or similar technique
- Specialty: Pediatric orthopedic surgery, and occasionally general orthopedics
Practices managing musculoskeletal surgical cases benefit from physical therapy EMR workflows that connect pre-operative documentation to post-operative billing. The claim then matches what the note records.
CPT code 20150 modifiers and when to apply them
Modifier selection for CPT code 20150 follows standard musculoskeletal surgery rules. The modifiers that come up most often cover laterality, bilateral procedures, and anesthesia. Confirm payer-specific modifier acceptance before you submit, because commercial policies vary more than Medicare’s.
Modifier 50 requires particular care. Some payers prefer two line items, one with RT and one with LT, while Medicare accepts a single line with modifier 50. Confirm payer preference before submission to avoid denials.
Modifier 51 also has limits. Add-on codes such as 15005 are exempt from it, so never append 51 to an add-on.
Reimbursement: Medicare rates and RVU breakdown
Medicare pays CPT code 20150 under the Medicare Physician Fee Schedule (MPFS), which CMS updates every calendar year. Payment also varies by geographic locality, so a single national figure will not match what your practice is paid. Look up the current rate for your locality with the CMS fee schedule lookup.
The code carries a 90-day global surgery period under Medicare. Routine pre-operative and post-operative visits inside that window are bundled into the surgical payment. Billing them separately without a modifier is a frequent claim error.
The three RVU components
Relative Value Units (RVUs) drive the physician payment formula under Medicare. The total RVU for 20150 has three components, and CMS updates each of them annually. Confirm the current values for your locality with the FastRVU lookup tool.
Facility and non-facility RVU values for 20150 differ materially. Hospital and ASC settings use the facility PE RVU, which is lower than the non-facility rate used for office-based procedures.
ASC payment status
Ambulatory surgery center (ASC) payment status determines whether a procedure is eligible for facility payment when performed outside a hospital. CPT code 20150 carries an ASC payment indicator that reflects its classification under the Outpatient Prospective Payment System (OPPS).
ASC payment indicators change with annual CMS rulemaking. Verify the indicator for 20150 for the current payment year before you schedule the case in an ASC. Billing an ASC-ineligible code in that setting triggers a denial that is hard to overturn on appeal.
Pro Tip
Verify 20150 ASC eligibility at the start of each calendar year using the CMS OPPS/ASC final rule addenda. Indicators publish in November for the following payment year, giving billing teams time to update coding protocols before January 1.
Documentation requirements payers look for
Claim denials for CPT code 20150 frequently trace back to incomplete operative reports. Payers require specific documentation elements to confirm medical necessity and support the code selected. Building clinical documentation workflows that capture these elements at the point of care reduces retrospective chart chasing.
- Diagnosis linkage: The operative report must link 20150 to a specific ICD-10-CM code for the underlying condition. A growth plate abnormality or post-traumatic physeal bar qualifies. Unspecified diagnosis codes raise denial risk.
- Bar characterization: Document the size, location, and extent of the epiphyseal bar (percentage of physeal area involved), as this establishes surgical necessity and complexity.
- Graft documentation: If a soft tissue graft is used, record the tissue type, the donor site, and the incision it came from. The descriptor bundles a graft obtained through the same fascial incision, so no separate harvest code is reported.
- Surgical technique: Describe the approach, instruments used, and method of bar excision. Fat interposition or graft interposition should be explicitly noted.
- Fluoroscopic guidance: If fluoroscopy was used intraoperatively, note whether NCCI edits bundle it for that payer or allow it separately.
- Pre-operative imaging: Reference the imaging study that confirmed the diagnosis and surgical plan (MRI or CT of the affected physeal region).
Practices using HIPAA-compliant documentation practices within their clinical software reduce audit exposure by maintaining a complete and retrievable record linked to each claim.
The National Correct Coding Initiative (NCCI) edits govern how 20150 bundles with concurrent codes. Verify the NCCI pairs before you submit more than one code from the same operative session.
Related codes that get confused with 20150
Several codes in the musculoskeletal CPT range overlap in description or context with CPT code 20150. Coding errors often stem from selecting an adjacent code without reading the full AMA descriptor. Review the AAPC Codify CPT lookup alongside the parenthetical notes in the CPT manual before finalizing code selection.
When a physeal bar excision is accompanied by an osteotomy to correct existing angular deformity, each procedure may be separately reportable. Confirm NCCI pairing and append modifier 51 appropriately. Practices running sports medicine software for musculoskeletal caseloads tend to find that structured billing templates cut code selection errors.
Common billing errors and how to avoid them
CPT code 20150 has a narrow clinical application, and its billing errors cluster around five recurring mistakes. Catching them before submission avoids the 30 to 60-day denial cycle.
- Unbundling the graft harvest: Reporting a separate graft harvest code alongside 20150 is the most common error. The descriptor already covers a soft tissue graft “obtained through same fascial incision.” A second code for that harvest is an unbundling violation, so remove it before submission.
- Missing laterality modifier: Submitting 20150 without an RT or LT modifier triggers edits from Medicare and most commercial payers. Apply the correct laterality modifier to every claim.
- Global period violations: An evaluation and management (E/M) visit inside the 90-day global period needs the right modifier. Use modifier 24 for an unrelated E/M and modifier 79 for an unrelated procedure. Without one, the claim denies automatically.
- Incomplete operative report: Payers auditing this code specifically look for documentation of bar size, approach, and graft interposition. A note that reads “physeal bar excised” without characterizing the bar fails medical necessity review.
- Wrong ICD-10-CM pairing: An unspecified fracture code or a general bone disorder code weakens the claim. Pair 20150 with the most specific code the chart supports. Fracture sequela codes such as S52.033J also carry their own encounter-character rules.
Pro Tip
Run a pre-submission audit on every 20150 claim with three checks. Is there a secondary graft harvest code on the claim? Is an RT or LT modifier present? Does the procedure date fall inside a prior global period for the same patient? Those three questions catch most denials for this code.
How practice management software supports CPT code 20150 billing
A code that appears once or twice a year carries more billing risk than its volume suggests. Staff familiarity fades between cases, and workflows tuned for high-volume codes rarely prompt for what 20150 needs.
Pabau’s claims management software gives orthopedic and pediatric surgical teams one place to build and submit claims. The claim is tied to the treatment record it came from, so the coder can see the operative note and the codes together.
That is where a missing RT modifier or a stray graft code gets caught. Instead of leaning on one coder’s memory for a code that appears twice a year, you build the checks into the workflow itself.
Three practice management software features matter most for surgical billing:
- Documentation linkage: The operative note ties to the claim it supports.
- Claim scrubbing: Errors surface before submission, not in a denial letter.
- Global period tracking: Each patient’s 90-day window is visible at booking.
Most errors originate where clinical documentation hands off to claim submission. Connecting surgical note templates to the billing workflow closes that handoff.
Prompts for modifier selection and ICD-10-CM pairing then treat the cause instead of the denial. Integrated practice management workflows keep clinical and billing teams on the same record.
Reduce surgical billing denials with Pabau
Keep surgical claims clean before they go out. Pabau keeps the operative note, the codes, and the claim in one record, so nothing goes out half-documented.
Conclusion
The trade-off with a code like 20150 is that you will never bill it often enough to get fluent in it. So the fluency has to live in the workflow instead of in a coder’s head.
Write the three checks down. Look for a second graft harvest code, confirm the laterality modifier, and check the patient’s global period. A practice that runs those before submission will not see many 20150 denials.
Building the checks into software rather than a paper checklist is what makes them survive staff turnover. Book a demo to see how Pabau links surgical documentation to claim submission for orthopedic practices.
Continue your research
Coding the wound that led to surgery? S41.021A pairs with the wound exploration codes that sit alongside 20150 in the musculoskeletal range.
Need the subsequent-encounter rules for musculoskeletal trauma? S33.4XXD walks through the encounter characters that decide whether a follow-up claim holds up.
Coding the arthritis that follows an uncorrected deformity? M18.4 covers secondary osteoarthritis and the specificity payers expect on the claim.
Wondering which system should own your billing data? Practice management system vs EMR explains how connected clinical and billing tools cut the errors behind complex code denials.
Building audit-ready surgical records? HIPAA compliance for medical offices covers the documentation and access controls that protect operative records.
Frequently asked questions
What does CPT code 20150 cover?
CPT code 20150 covers surgical excision of an epiphyseal bar, the bony bridge that forms across a growth plate. The full descriptor reads “excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through same fascial incision.” That wording bundles the graft, so the harvest is not billed separately.
Which modifiers apply to CPT code 20150?
RT and LT cover laterality, and modifier 50 reports a bilateral procedure at 150% of the single-procedure rate under Medicare. Modifier 51 applies to multiple procedures in one session, and modifier 22 to unusually complex work. Modifier 47 applies only when the surgeon administers the anesthesia. Most payers require a laterality modifier on every claim.
What is the Medicare reimbursement rate for 20150?
Medicare payment for 20150 is set annually through the Medicare Physician Fee Schedule and varies by locality. Look up the current rate for your payment year with the CMS Physician Fee Schedule lookup tool. Any figure quoted elsewhere goes stale with the next MPFS update.
Is 20150 payable in an ASC setting?
ASC eligibility depends on the payment indicator CMS assigns in the annual OPPS/ASC final rule. That indicator can change from one payment year to the next. Verify the current status through the CMS ASC payment system before scheduling the case at an ASC.
Can a graft harvest be billed separately with 20150?
No. The descriptor reads “with or without autogenous soft tissue graft obtained through same fascial incision,” which bundles the harvest into the base code. Reporting a separate harvest code alongside 20150 is an unbundling violation under NCCI edits. Expect a denial or an audit.
What documentation does 20150 require?
The operative report needs the size, location, and extent of the epiphyseal bar. It also needs the surgical approach, the excision technique, and the graft and interposition method if one was used. Add the pre-operative imaging that confirmed the diagnosis and a specific ICD-10-CM code on the claim. Incomplete documentation drives most denials for this code.
