CPT code 20600: Joint aspiration/injection, small joint, without ultrasound2026 Medicare rate & RVUs in Houston, TX

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.

CMS RVU26DEffective Oct 1, 2026One payment locality436.6K Medicare services in 2024

In Houston, TX, Medicare pays $57.06 for 20600 in the office and $32.52 when it’s performed in a hospital or facility.

$57.06Office (non-facility)
$32.52Hospital or facility
+1.7%vs the national office rate ($56.11)

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.

We’ll open 20600 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Houston, TX
  2. What 20600 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 Houston, TX 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. Houston, TX pays $57.06. The RVUs are the same everywhere; the geographic indexes change the dollars.

20600 in Houston, TX vs other payment areas
  1. Houston, TX · this page$57.06
  2. Austin, TX · Texas$57.71+$0.65
  3. Beaumont, TX · Texas$53.04−$4.02
  4. Brazoria, TX · Texas$55.41−$1.65
  5. Dallas, TX · Texas$55.80−$1.26
  6. Fort Worth, TX · Texas$55.51−$1.55
  7. Galveston, TX · Texas$55.60−$1.46

Other areas in Texas first, then benchmark localities. Bars start at $0.

Every other payment area

20600 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$54.22$30.76
Los Angeles, CACalifornia$61.96$32.72
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

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
20600 office rate range by state
State / territoryOffice rate rangeLocalities
AK$67.691
AL$50.951
AR$50.301
AZ$54.731
CA$58.32–$71.4029
CO$57.841
CT$59.571
DC$63.281
DE$55.571
FL$56.05–$61.513
GA$53.16–$57.232
GU$59.381
HI$59.381
IA$51.781
ID$52.141
IL$54.83–$59.884
IN$52.401
KS$51.711
KY$52.331
LA$52.31–$54.592
MA$57.61–$62.922
MD$56.49–$63.283
ME$52.54–$54.842
MI$53.67–$56.822
MN$55.161
MO$51.62–$54.583
MS$50.961
MT$56.111
NC$53.001
ND$54.531
NE$51.981
NH$57.091
NJ$60.18–$62.772
NM$53.991
NV$55.701
NY$53.72–$65.835
OH$53.351
OK$52.091
OR$55.19–$59.332
PA$53.34–$58.332
PR$56.431
RI$57.291
SC$53.281
SD$54.341
TN$51.961
TX$53.04–$57.718
UT$53.921
VA$54.78–$63.282
VI$56.431
VT$54.471
WA$57.45–$63.972
WI$52.921
WV$53.061
WY$55.421

See 20600 in every payment locality

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

Office or facility?

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 Houston, TX 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 20600 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work0.64× 1.0080.6451
Practice expense0.96× 0.9930.9533
Malpractice0.08× 1.3760.1101
Total RVUs1.7085
Conversion factor× 33.4009

Office rate, Houston, TX$57.06

Office: (0.64 × 1.008 + 0.96 × 0.993 + 0.08 × 1.376) × $33.4009 = $57.06

Facility: (0.64 × 1.008 + 0.22 × 0.993 + 0.08 × 1.376) × $33.4009 = $32.52

Open 20600 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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).

When to use modifier 50

How 20600 has changed in Houston, TX

20600 · Office / nonfacility

$57.06

Effective 2026-10-01

The base rate is $3.22 higher than on 2025-10-01, moving from $53.84 to $57.06 (6.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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
  1. January 1, 2026

    RVU26A

    $53.84changed to$57.06

    • 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 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $55.55changed to$53.84

    • 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.

  3. March 9, 2024

    RVU24AR

    $54.64changed to$55.55

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $54.93changed to$54.64

    • 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 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409
  5. January 1, 2023

    RVU23A

    $55.57changed to$54.93

    • 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 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $54.24changed to$55.57

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 0.77 changed to 0.82

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $52.82changed to$54.24

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.69 changed to 0.77
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $50.30changed to$52.82

    • 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 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $49.91changed to$50.30

    • Conversion factor 35.9996 changed to 36.0391
    • Malpractice RVU 0.07 changed to 0.08

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $49.35changed to$49.91

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 0.63 changed to 0.64
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $48.81changed to$49.35

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 0.62 changed to 0.63
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $48.98changed to$48.81

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $48.74changed to$48.98

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $48.63changed to$48.74

    • Conversion factor 35.8228 changed to 35.7547
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $47.36changed to$48.63

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.66 changed to 0.62
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $47.36

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$57.06$32.52RVU26D
2026-07-01$57.06$32.52RVU26C
2026-04-01$57.06$32.52RVU26B
2026-01-01$57.06$32.52RVU26A
2025-10-01$53.84$36.00RVU25D
2025-07-01$53.84$36.00RVU25C
2025-04-01$53.84$36.00RVU25B
2025-01-01$53.84$36.00RVU25A
2024-10-01$55.55$37.18RVU24D
2024-07-01$55.55$37.18RVU24C
2024-04-01$55.55$37.18RVU24B
2024-03-09$55.55$37.18RVU24AR
2024-01-01$54.64$36.58RVU24A
2023-10-01$54.93$36.68RVU23D
2023-07-01$54.93$36.68RVU23C
2023-04-01$54.93$36.68RVU23B
2023-01-01$54.93$36.68RVU23A
2022-10-01$55.57$37.06RVU22D
2022-07-01$55.57$37.06RVU22C
2022-04-01$55.57$37.06RVU22B
2022-01-01$55.57$37.06RVU22A
2021-10-01$54.24$37.36RVU21D
2021-07-01$54.24$37.36RVU21C
2021-04-01$54.24$37.36RVU21B
2021-01-01$54.24$37.36RVU21A
2020-10-01$52.82$38.10RVU20D
2020-07-01$52.82$38.10RVU20C
2020-04-01$52.82$38.10RVU20B
2020-01-01$52.82$38.10RVU20A
2019-10-01$50.30$37.54RVU19D
2019-07-01$50.30$37.54RVU19C
2019-04-01$50.30$37.54RVU19B
2019-01-01$50.30$37.54RVU19A
2018-10-01$49.91$37.16RVU18D
2018-07-01$49.91$37.16RVU18C
2018-04-01$49.91$37.16RVU18B
2018-01-01$49.91$37.16RVU18AR1
2017-10-01$49.35$37.04RVU17D
2017-07-01$49.35$37.04RVU17C
2017-04-01$49.35$37.04RVU17B
2017-01-01$49.35$37.04RVU17A
2016-10-01$48.81$36.92RVU16D
2016-07-01$48.81$36.92RVU16C
2016-04-01$48.81$36.92RVU16B
2016-01-01$48.81$36.92RVU16A
2015-10-01$48.98$37.05RVU15D
2015-07-01$48.98$37.05RVU15C
2015-04-01$48.74$36.87RVU15B
2015-01-01$48.74$36.87RVU15A
2014-10-01$48.63$36.76RVU14D
2014-07-01$48.63$36.76RVU14C
2014-04-01$48.63$36.76RVU14B
2014-01-01$48.63$36.76RVU14A
2013-10-01$47.36$35.08RVU13D
2013-07-01$47.36$35.08RVU13C
2013-04-01$47.36$35.08RVU13B
2013-01-01$47.36$35.08RVU13AR

Price 20600 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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
RVUs for 20600PPRRVU2026_Oct_nonQPP.csv, line 1,766 (RVU26D)
Geographic factors for Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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