CPT code 20600: Joint aspiration/injection, small joint, without ultrasound2026 Medicare rate & RVUs in Madera, CA
Reports aspiration and/or injection of a small joint or bursa, such as a finger or toe joint, when the service is performed without ultrasound guidance.
In Madera, CA, Medicare pays $58.32 for 20600 in the office and $31.23 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 20600 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 20600 covers
This service covers needle aspiration, injection, or both in a small joint or bursa without ultrasound guidance. Common sites include the metacarpophalangeal or interphalangeal joints of the hand and the joints of the toes. Orthopedists, rheumatologists, primary care clinicians, and other clinicians who treat joint symptoms may perform it in an office or facility setting. Aspiration may be performed to evaluate or relieve a small-joint effusion; injection may be used to treat a joint condition or local inflammation.
Select the code by the treated structure’s size and whether ultrasound guidance is used: use 20600 for a small joint or bursa without ultrasound, 20604 for the ultrasound-guided small-joint service, and different codes for intermediate or major structures. Document the site, laterality, indication, and aspiration or injection performed. The 0-day global period includes same-day preoperative and postoperative care. For bilateral treatment, modifier 50 is paid at 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Madera, CA compares for 20600
Across 109 of 109 payment localities, the office rate for 20600 runs from $50.30 in Arkansas to $71.40 in San Benito County, CA. Madera, CA pays $58.32. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Madera, CA · this page$58.32
- Bakersfield, CA · California$58.55+$0.23
- Chico, CA · California$58.32
- El Centro, CA · California$58.33+$0.01
- Fresno, CA · California$58.32
- Hanford, CA · California$58.32
- Los Angeles, CA · California$61.96+$3.64
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Merced, CACalifornia | $58.32 | $31.23 |
| Modesto, CACalifornia | $58.32 | $31.23 |
| Napa, CACalifornia | $66.34 | $33.77 |
| Oxnard, CACalifornia | $61.54 | $32.33 |
| Redding, CACalifornia | $58.32 | $31.23 |
| Rest of CaliforniaCalifornia | $58.32 | $31.23 |
| Riverside, CACalifornia | $59.18 | $32.09 |
| Sacramento, CACalifornia | $60.87 | $32.12 |
| Salinas, CACalifornia | $60.63 | $31.99 |
| San Diego, CACalifornia | $61.82 | $32.25 |
| Marin County, CACalifornia | $69.85 | $34.99 |
| San Francisco, CACalifornia | $69.75 | $34.90 |
| San Benito County, CACalifornia | $71.40 | $35.76 |
| Santa Clara County, CACalifornia | $71.03 | $35.38 |
| San Luis Obispo, CACalifornia | $59.69 | $31.54 |
| Santa Cruz, CACalifornia | $62.22 | $32.19 |
| Santa Maria, CACalifornia | $60.79 | $31.98 |
| Santa Rosa, CACalifornia | $62.83 | $32.47 |
| Stockton, CACalifornia | $58.32 | $31.23 |
| Vallejo, CACalifornia | $66.21 | $33.63 |
| Visalia, CACalifornia | $58.32 | $31.23 |
| Yuba City, CACalifornia | $58.32 | $31.23 |
| Washington, DC areaDistrict of Columbia | $63.28 | $34.16 |
| Miami, FLFlorida | $61.51 | $35.78 |
| Chicago, ILIllinois | $59.88 | $35.04 |
| Manhattan, NYNew York | $64.24 | $35.52 |
| AlaskaAlaska | $67.69 | $41.36 |
| AlabamaAlabama | $50.95 | $29.32 |
| ArkansasArkansas | $50.30 | $29.06 |
| ArizonaArizona | $54.73 | $30.78 |
| ColoradoColorado | $57.84 | $31.54 |
| ConnecticutConnecticut | $59.57 | $32.95 |
| DelawareDelaware | $55.57 | $31.15 |
| Fort Lauderdale, FLFlorida | $58.69 | $33.65 |
| Rest of FloridaFlorida | $56.05 | $32.42 |
| Atlanta, GAGeorgia | $57.23 | $32.12 |
| Rest of GeorgiaGeorgia | $53.16 | $31.12 |
| Hawaii, Guam, HIHawaii | $59.38 | $31.28 |
| IowaIowa | $51.78 | $29.16 |
| IdahoIdaho | $52.14 | $29.40 |
| East St. Louis, ILIllinois | $56.26 | $33.52 |
| Rest of IllinoisIllinois | $54.83 | $32.26 |
| Suburban Chicago, ILIllinois | $59.19 | $33.81 |
| IndianaIndiana | $52.40 | $29.49 |
| KansasKansas | $51.71 | $29.37 |
| KentuckyKentucky | $52.33 | $30.35 |
| New Orleans, LALouisiana | $54.59 | $31.33 |
| Rest of LouisianaLouisiana | $52.31 | $30.44 |
| Metropolitan Boston, MAMassachusetts | $62.92 | $33.40 |
| Rest of MassachusettsMassachusetts | $57.61 | $31.59 |
| Baltimore area, MDMaryland | $59.43 | $32.91 |
| Rest of MarylandMaryland | $56.49 | $31.48 |
| Rest of MaineMaine | $52.54 | $29.80 |
| Southern Maine, MEMaine | $54.84 | $30.34 |
| Detroit, MIMichigan | $56.82 | $32.97 |
| Rest of MichiganMichigan | $53.67 | $31.10 |
| MinnesotaMinnesota | $55.16 | $29.73 |
| Metropolitan Kansas City, MOMissouri | $54.10 | $30.89 |
| Metropolitan St. Louis, MOMissouri | $54.58 | $31.05 |
| Rest of MissouriMissouri | $51.62 | $30.31 |
| MississippiMississippi | $50.96 | $29.68 |
| MontanaMontana | $56.11 | $31.39 |
| North CarolinaNorth Carolina | $53.00 | $29.94 |
| North DakotaNorth Dakota | $54.53 | $29.81 |
| NebraskaNebraska | $51.98 | $29.17 |
| New HampshireNew Hampshire | $57.09 | $31.36 |
| Northern New JerseyNew Jersey | $62.77 | $34.10 |
| Rest of New JerseyNew Jersey | $60.18 | $33.19 |
| New MexicoNew Mexico | $53.99 | $31.32 |
| NevadaNevada | $55.70 | $30.96 |
| NYC suburbs and Long Island, NYNew York | $65.83 | $36.44 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $60.68 | $33.62 |
| Queens, NYNew York | $64.50 | $35.28 |
| Rest of New YorkNew York | $53.72 | $30.24 |
| OhioOhio | $53.35 | $30.78 |
| OklahomaOklahoma | $52.09 | $30.01 |
| Portland, OROregon | $59.33 | $31.87 |
| Rest of OregonOregon | $55.19 | $30.57 |
| Metropolitan Philadelphia, PAPennsylvania | $58.33 | $32.60 |
| Rest of PennsylvaniaPennsylvania | $53.34 | $30.65 |
| Puerto RicoPuerto Rico | $56.43 | $31.44 |
| Rhode IslandRhode Island | $57.29 | $31.76 |
| South CarolinaSouth Carolina | $53.28 | $30.44 |
| South DakotaSouth Dakota | $54.34 | $29.62 |
| TennesseeTennessee | $51.96 | $29.49 |
| Austin, TXTexas | $57.71 | $31.56 |
| Beaumont, TXTexas | $53.04 | $30.55 |
| Brazoria, TXTexas | $55.41 | $30.91 |
| Dallas, TXTexas | $55.80 | $31.18 |
| Fort Worth, TXTexas | $55.51 | $31.14 |
| Galveston, TXTexas | $55.60 | $31.06 |
| Houston, TXTexas | $57.06 | $32.52 |
| Rest of TexasTexas | $54.22 | $30.76 |
| UtahUtah | $53.92 | $30.68 |
| VirginiaVirginia | $54.78 | $30.49 |
| Virgin Islands, VIUnited States Virgin Islands | $56.43 | $31.44 |
| VermontVermont | $54.47 | $30.00 |
| Rest of WashingtonWashington | $57.45 | $31.43 |
| King County, WAWashington | $63.97 | $33.64 |
| WisconsinWisconsin | $52.92 | $29.24 |
| West VirginiaWest Virginia | $53.06 | $31.59 |
| WyomingWyoming | $55.42 | $30.70 |
20600 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$50.30
$67.69
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $67.69 | 1 |
| AL | $50.95 | 1 |
| AR | $50.30 | 1 |
| AZ | $54.73 | 1 |
| CA | $58.32–$71.40 | 29 |
| CO | $57.84 | 1 |
| CT | $59.57 | 1 |
| DC | $63.28 | 1 |
| DE | $55.57 | 1 |
| FL | $56.05–$61.51 | 3 |
| GA | $53.16–$57.23 | 2 |
| GU | $59.38 | 1 |
| HI | $59.38 | 1 |
| IA | $51.78 | 1 |
| ID | $52.14 | 1 |
| IL | $54.83–$59.88 | 4 |
| IN | $52.40 | 1 |
| KS | $51.71 | 1 |
| KY | $52.33 | 1 |
| LA | $52.31–$54.59 | 2 |
| MA | $57.61–$62.92 | 2 |
| MD | $56.49–$63.28 | 3 |
| ME | $52.54–$54.84 | 2 |
| MI | $53.67–$56.82 | 2 |
| MN | $55.16 | 1 |
| MO | $51.62–$54.58 | 3 |
| MS | $50.96 | 1 |
| MT | $56.11 | 1 |
| NC | $53.00 | 1 |
| ND | $54.53 | 1 |
| NE | $51.98 | 1 |
| NH | $57.09 | 1 |
| NJ | $60.18–$62.77 | 2 |
| NM | $53.99 | 1 |
| NV | $55.70 | 1 |
| NY | $53.72–$65.83 | 5 |
| OH | $53.35 | 1 |
| OK | $52.09 | 1 |
| OR | $55.19–$59.33 | 2 |
| PA | $53.34–$58.33 | 2 |
| PR | $56.43 | 1 |
| RI | $57.29 | 1 |
| SC | $53.28 | 1 |
| SD | $54.34 | 1 |
| TN | $51.96 | 1 |
| TX | $53.04–$57.71 | 8 |
| UT | $53.92 | 1 |
| VA | $54.78–$63.28 | 2 |
| VI | $56.43 | 1 |
| VT | $54.47 | 1 |
| WA | $57.45–$63.97 | 2 |
| WI | $52.92 | 1 |
| WV | $53.06 | 1 |
| WY | $55.42 | 1 |
How the 20600 rate is calculated
Each of 20600’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 20600
RVUs × geographic indexes × conversion factor
Work0.64
0.64 RVUs× 1.000 GPCI
Practice expense0.96
0.96 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
1.6800
Conversion factor
$33.4009
Medicare rate
$56.11
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Madera, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,766
- Code
- 20600
- Physician work
- 0.64
- Practice expense
- 0.96
- Malpractice
- 0.08
GPCI2026.csv
14
- Locality
- Madera, CA
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.64 | × 1.017 | 0.6509 |
| Practice expense | 0.96 | × 1.096 | 1.0522 |
| Malpractice | 0.08 | × 0.536 | 0.0429 |
| Total RVUs | 1.7459 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Madera, CA$58.32
Office: (0.64 × 1.017 + 0.96 × 1.096 + 0.08 × 0.536) × $33.4009 = $58.32
Facility: (0.64 × 1.017 + 0.22 × 1.096 + 0.08 × 0.536) × $33.4009 = $31.23
Payment rules and modifiers for 20600
The CMS indicators that decide how 20600 is paid alongside other services.
CMS payment indicators · 20600
Joint aspiration/injection, small joint, without ultrasound
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
20600 without 50 · national office
$56.11
Joint aspiration/injection, small joint, without ultrasound
20600-50 · Bilateral: 150%
$84.17
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
How 20600 has changed in Madera, CA
20600 · Office / nonfacility
$58.32
Effective 2026-10-01
The base rate is $4.11 higher than on 2025-10-01, moving from $54.21 to $58.32 (7.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$54.21changed to$58.32
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.66 changed to 0.64
- Practice expense RVU 0.88 changed to 0.96
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$55.61changed to$54.21
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.87 changed to 0.88
- Malpractice RVU 0.09 changed to 0.08
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$54.70changed to$55.61
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$55.12changed to$54.70
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.84 changed to 0.87
- Malpractice RVU 0.08 changed to 0.09
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$55.54changed to$55.12
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.82 changed to 0.84
- Malpractice RVU 0.09 changed to 0.08
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$54.14changed to$55.54
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.77 changed to 0.82
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$52.92changed to$54.14
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.69 changed to 0.77
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$50.65changed to$52.92
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.64 changed to 0.69
- Malpractice RVU 0.08 changed to 0.09
- Work GPCI 1.020 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$50.40changed to$50.65
- Conversion factor 35.9996 changed to 36.0391
- Malpractice RVU 0.07 changed to 0.08
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$50.18changed to$50.40
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.63 changed to 0.64
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$50.18
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $58.32 | $31.23 | RVU26D |
| 2026-07-01 | $58.32 | $31.23 | RVU26C |
| 2026-04-01 | $58.32 | $31.23 | RVU26B |
| 2026-01-01 | $58.32 | $31.23 | RVU26A |
| 2025-10-01 | $54.21 | $34.76 | RVU25D |
| 2025-07-01 | $54.21 | $34.76 | RVU25C |
| 2025-04-01 | $54.21 | $34.76 | RVU25B |
| 2025-01-01 | $54.21 | $34.76 | RVU25A |
| 2024-10-01 | $55.61 | $35.60 | RVU24D |
| 2024-07-01 | $55.61 | $35.60 | RVU24C |
| 2024-04-01 | $55.61 | $35.60 | RVU24B |
| 2024-03-09 | $55.61 | $35.60 | RVU24AR |
| 2024-01-01 | $54.70 | $35.02 | RVU24A |
| 2023-10-01 | $55.12 | $35.74 | RVU23D |
| 2023-07-01 | $55.12 | $35.74 | RVU23C |
| 2023-04-01 | $55.12 | $35.74 | RVU23B |
| 2023-01-01 | $55.12 | $35.74 | RVU23A |
| 2022-10-01 | $55.54 | $36.37 | RVU22D |
| 2022-07-01 | $55.54 | $36.37 | RVU22C |
| 2022-04-01 | $55.54 | $36.37 | RVU22B |
| 2022-01-01 | $55.54 | $36.37 | RVU22A |
| 2021-10-01 | $54.14 | $36.67 | RVU21D |
| 2021-07-01 | $54.14 | $36.67 | RVU21C |
| 2021-04-01 | $54.14 | $36.67 | RVU21B |
| 2021-01-01 | $54.14 | $36.67 | RVU21A |
| 2020-10-01 | $52.92 | $37.47 | RVU20D |
| 2020-07-01 | $52.92 | $37.47 | RVU20C |
| 2020-04-01 | $52.92 | $37.47 | RVU20B |
| 2020-01-01 | $52.92 | $37.47 | RVU20A |
| 2019-10-01 | $50.65 | $37.11 | RVU19D |
| 2019-07-01 | $50.65 | $37.11 | RVU19C |
| 2019-04-01 | $50.65 | $37.11 | RVU19B |
| 2019-01-01 | $50.65 | $37.11 | RVU19A |
| 2018-10-01 | $50.40 | $36.86 | RVU18D |
| 2018-07-01 | $50.40 | $36.86 | RVU18C |
| 2018-04-01 | $50.40 | $36.86 | RVU18B |
| 2018-01-01 | $50.40 | $36.86 | RVU18AR1 |
| 2017-10-01 | $50.18 | $37.02 | RVU17D |
| 2017-07-01 | $50.18 | $37.02 | RVU17C |
| 2017-04-01 | $50.18 | $37.02 | RVU17B |
| 2017-01-01 | $50.18 | $37.02 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Madera, CA rate applies
Madera, CA is a Medicare payment area, not a city. Our Census mapping connects it to 17 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Madera
- Ahwahnee
- Bass Lake
- Bonadelle Ranchos
- Chowchilla
- Coarsegold
- Fairmead
- La Vina
20600 billing questions
When should 20600 be chosen instead of 20604?
Use 20600 for a small joint or bursa treated without ultrasound guidance. When ultrasound guidance is used for the small-joint service, use 20604.
How is a small joint distinguished from an intermediate joint?
20600 is for small joints, such as finger or toe joints; 20605 is for an intermediate joint or bursa. Select based on the treated structure, not the medication injected.
Can aspiration and injection at the same small joint be reported separately?
The service includes aspiration, injection, or both at the treated small joint or bursa. Do not report separate units merely because both actions were performed at that site.
How should bilateral small-joint treatment be reported?
When the procedure is performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.
What documentation supports reporting 20600?
Identify the small joint or bursa, side, clinical reason, whether fluid was aspirated or medication injected, and that ultrasound guidance was not used.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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