CPT code 20604: Joint aspiration or injection, small joint or bursa2026 Medicare rate & RVUs in Washington, DC area
Report this service when a clinician aspirates fluid from or injects a small joint or bursa using ultrasound guidance with permanent image recording.
In Washington, DC area, Medicare pays $98.85 for 20604 in the office and $42.98 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 20604 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 20604 covers
An orthopedist, rheumatologist, sports medicine physician, or other qualified clinician uses ultrasound to guide a needle into a small joint or bursa for fluid removal, medication delivery, or both. Common targets include joints of the fingers or toes. The ultrasound guidance, permanent image recording, and reporting are part of the service. It may be performed in an office or facility setting.
Choose this code for a small joint or bursa, rather than an intermediate or major target; document the site, whether aspiration, injection, or both occurred, and the ultrasound guidance and saved images. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. For bilateral services reported with modifier 50, CMS pays 150%. Assistant-at-surgery services are not paid; 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 Washington, DC area compares for 20604
Across 109 of 109 payment localities, the office rate for 20604 runs from $77.72 in Arkansas to $112.73 in San Benito County, CA. Washington, DC area pays $98.85. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Washington, DC area · this page$98.85
- Los Angeles, CA · California$97.10−$1.75
- Miami, FL · Florida$95.03−$3.82
- Chicago, IL · Illinois$92.41−$6.44
- Manhattan, NY · New York$100.01+$1.16
- Alaska · Alaska$103.59+$4.74
- Alabama · Alabama$78.78−$20.07
Other areas in District of Columbia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $77.72 | $36.98 |
| ArizonaArizona | $84.96 | $39.00 |
| Bakersfield, CACalifornia | $91.52 | $39.54 |
| Chico, CACalifornia | $91.19 | $39.21 |
| El Centro, CACalifornia | $91.21 | $39.23 |
| Fresno, CACalifornia | $91.19 | $39.21 |
| Hanford, CACalifornia | $91.19 | $39.21 |
| Madera, CACalifornia | $91.19 | $39.21 |
| Merced, CACalifornia | $91.19 | $39.21 |
| Modesto, CACalifornia | $91.19 | $39.21 |
| Napa, CACalifornia | $104.51 | $42.00 |
| Oxnard, CACalifornia | $96.51 | $40.45 |
| Redding, CACalifornia | $91.19 | $39.21 |
| Rest of CaliforniaCalifornia | $91.19 | $39.21 |
| Riverside, CACalifornia | $92.39 | $40.40 |
| Sacramento, CACalifornia | $95.39 | $40.23 |
| Salinas, CACalifornia | $95.03 | $40.06 |
| San Diego, CACalifornia | $97.04 | $40.31 |
| Marin County, CACalifornia | $110.27 | $43.40 |
| San Francisco, CACalifornia | $110.15 | $43.27 |
| San Benito County, CACalifornia | $112.73 | $44.34 |
| Santa Clara County, CACalifornia | $112.22 | $43.83 |
| San Luis Obispo, CACalifornia | $93.53 | $39.51 |
| Santa Cruz, CACalifornia | $97.79 | $40.16 |
| Santa Maria, CACalifornia | $95.32 | $40.02 |
| Santa Rosa, CACalifornia | $98.76 | $40.51 |
| Stockton, CACalifornia | $91.19 | $39.21 |
| Vallejo, CACalifornia | $104.33 | $41.82 |
| Visalia, CACalifornia | $91.19 | $39.21 |
| Yuba City, CACalifornia | $91.19 | $39.21 |
| ColoradoColorado | $90.20 | $39.74 |
| ConnecticutConnecticut | $92.72 | $41.64 |
| DelawareDelaware | $86.30 | $39.44 |
| Fort Lauderdale, FLFlorida | $90.85 | $42.81 |
| Rest of FloridaFlorida | $86.63 | $41.29 |
| Atlanta, GAGeorgia | $88.87 | $40.68 |
| Rest of GeorgiaGeorgia | $82.00 | $39.69 |
| Hawaii, Guam, HIHawaii | $93.09 | $39.16 |
| IowaIowa | $80.33 | $36.94 |
| IdahoIdaho | $80.88 | $37.25 |
| East St. Louis, ILIllinois | $86.55 | $42.91 |
| Rest of IllinoisIllinois | $84.51 | $41.21 |
| Suburban Chicago, ILIllinois | $91.69 | $42.98 |
| IndianaIndiana | $81.31 | $37.35 |
| KansasKansas | $80.13 | $37.25 |
| KentuckyKentucky | $80.82 | $38.66 |
| New Orleans, LALouisiana | $84.46 | $39.83 |
| Rest of LouisianaLouisiana | $80.76 | $38.79 |
| Metropolitan Boston, MAMassachusetts | $98.53 | $41.90 |
| Rest of MassachusettsMassachusetts | $89.78 | $39.84 |
| Baltimore area, MDMaryland | $92.49 | $41.59 |
| Rest of MarylandMaryland | $87.82 | $39.82 |
| Rest of MaineMaine | $81.43 | $37.80 |
| Southern Maine, MEMaine | $85.33 | $38.33 |
| Detroit, MIMichigan | $87.79 | $42.02 |
| Rest of MichiganMichigan | $82.91 | $39.61 |
| MinnesotaMinnesota | $86.17 | $37.36 |
| Metropolitan Kansas City, MOMissouri | $83.77 | $39.23 |
| Metropolitan St. Louis, MOMissouri | $84.57 | $39.42 |
| Rest of MissouriMissouri | $79.57 | $38.68 |
| MississippiMississippi | $78.65 | $37.81 |
| MontanaMontana | $87.17 | $39.74 |
| North CarolinaNorth Carolina | $82.20 | $37.95 |
| North DakotaNorth Dakota | $84.99 | $37.56 |
| NebraskaNebraska | $80.70 | $36.92 |
| New HampshireNew Hampshire | $88.95 | $39.58 |
| Northern New JerseyNew Jersey | $97.97 | $42.95 |
| Rest of New JerseyNew Jersey | $93.70 | $41.91 |
| New MexicoNew Mexico | $83.40 | $39.90 |
| NevadaNevada | $86.62 | $39.14 |
| NYC suburbs and Long Island, NYNew York | $102.47 | $46.08 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $94.43 | $42.49 |
| Queens, NYNew York | $100.57 | $44.51 |
| Rest of New YorkNew York | $83.36 | $38.31 |
| OhioOhio | $82.47 | $39.17 |
| OklahomaOklahoma | $80.53 | $38.18 |
| Portland, OROregon | $92.74 | $40.05 |
| Rest of OregonOregon | $85.87 | $38.63 |
| Metropolitan Philadelphia, PAPennsylvania | $90.64 | $41.27 |
| Rest of PennsylvaniaPennsylvania | $82.51 | $38.97 |
| Puerto RicoPuerto Rico | $87.72 | $39.77 |
| Rhode IslandRhode Island | $89.13 | $40.13 |
| South CarolinaSouth Carolina | $82.49 | $38.66 |
| South DakotaSouth Dakota | $84.74 | $37.31 |
| TennesseeTennessee | $80.52 | $37.41 |
| Austin, TXTexas | $89.97 | $39.79 |
| Beaumont, TXTexas | $82.02 | $38.85 |
| Brazoria, TXTexas | $86.11 | $39.11 |
| Dallas, TXTexas | $86.70 | $39.46 |
| Fort Worth, TXTexas | $86.20 | $39.44 |
| Galveston, TXTexas | $86.40 | $39.30 |
| Houston, TXTexas | $88.41 | $41.31 |
| Rest of TexasTexas | $84.04 | $39.03 |
| UtahUtah | $83.53 | $38.95 |
| VirginiaVirginia | $85.17 | $38.55 |
| Virgin Islands, VIUnited States Virgin Islands | $87.72 | $39.77 |
| VermontVermont | $84.82 | $37.86 |
| Rest of WashingtonWashington | $89.56 | $39.62 |
| King County, WAWashington | $100.32 | $42.12 |
| WisconsinWisconsin | $82.35 | $36.91 |
| West VirginiaWest Virginia | $81.63 | $40.41 |
| WyomingWyoming | $86.22 | $38.79 |
20604 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.
$77.72
$103.59
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 | $103.59 | 1 |
| AL | $78.78 | 1 |
| AR | $77.72 | 1 |
| AZ | $84.96 | 1 |
| CA | $91.19–$112.73 | 29 |
| CO | $90.20 | 1 |
| CT | $92.72 | 1 |
| DC | $98.85 | 1 |
| DE | $86.30 | 1 |
| FL | $86.63–$95.03 | 3 |
| GA | $82.00–$88.87 | 2 |
| GU | $93.09 | 1 |
| HI | $93.09 | 1 |
| IA | $80.33 | 1 |
| ID | $80.88 | 1 |
| IL | $84.51–$92.41 | 4 |
| IN | $81.31 | 1 |
| KS | $80.13 | 1 |
| KY | $80.82 | 1 |
| LA | $80.76–$84.46 | 2 |
| MA | $89.78–$98.53 | 2 |
| MD | $87.82–$98.85 | 3 |
| ME | $81.43–$85.33 | 2 |
| MI | $82.91–$87.79 | 2 |
| MN | $86.17 | 1 |
| MO | $79.57–$84.57 | 3 |
| MS | $78.65 | 1 |
| MT | $87.17 | 1 |
| NC | $82.20 | 1 |
| ND | $84.99 | 1 |
| NE | $80.70 | 1 |
| NH | $88.95 | 1 |
| NJ | $93.70–$97.97 | 2 |
| NM | $83.40 | 1 |
| NV | $86.62 | 1 |
| NY | $83.36–$102.47 | 5 |
| OH | $82.47 | 1 |
| OK | $80.53 | 1 |
| OR | $85.87–$92.74 | 2 |
| PA | $82.51–$90.64 | 2 |
| PR | $87.72 | 1 |
| RI | $89.13 | 1 |
| SC | $82.49 | 1 |
| SD | $84.74 | 1 |
| TN | $80.52 | 1 |
| TX | $82.02–$89.97 | 8 |
| UT | $83.53 | 1 |
| VA | $85.17–$98.85 | 2 |
| VI | $87.72 | 1 |
| VT | $84.82 | 1 |
| WA | $89.56–$100.32 | 2 |
| WI | $82.35 | 1 |
| WV | $81.63 | 1 |
| WY | $86.22 | 1 |
How the 20604 rate is calculated
Each of 20604’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 · 20604
RVUs × geographic indexes × conversion factor
Work0.87
0.87 RVUs× 1.000 GPCI
Practice expense1.63
1.63 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
2.6100
Conversion factor
$33.4009
Medicare rate
$87.18
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Washington, DC area inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,767
- Code
- 20604
- Physician work
- 0.87
- Practice expense
- 1.63
- Malpractice
- 0.11
GPCI2026.csv
39
- Locality
- Washington, DC area
- Physician work
- 1.054
- Practice expense
- 1.178
- Malpractice
- 1.113
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.87 | × 1.054 | 0.9170 |
| Practice expense | 1.63 | × 1.178 | 1.9201 |
| Malpractice | 0.11 | × 1.113 | 0.1224 |
| Total RVUs | 2.9595 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Washington, DC area$98.85
Office: (0.87 × 1.054 + 1.63 × 1.178 + 0.11 × 1.113) × $33.4009 = $98.85
Facility: (0.87 × 1.054 + 0.21 × 1.178 + 0.11 × 1.113) × $33.4009 = $42.98
Payment rules and modifiers for 20604
The CMS indicators that decide how 20604 is paid alongside other services.
CMS payment indicators · 20604
Joint aspiration or injection, small joint or bursa
| 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
20604 without 50 · national office
$87.18
Joint aspiration or injection, small joint or bursa
20604-50 · Bilateral: 150%
$130.77
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 20604 has changed in Washington, DC area
20604 · Office / nonfacility
$98.85
Effective 2026-10-01
The base rate is $6.44 higher than on 2025-10-01, moving from $92.41 to $98.85 (7.0%).
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
$92.41changed to$98.85
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.89 changed to 0.87
- Practice expense RVU 1.49 changed to 1.63
- Malpractice RVU 0.12 changed to 0.11
- Work GPCI 1.057 changed to 1.054
- Practice expense GPCI 1.192 changed to 1.178
- Malpractice GPCI 1.168 changed to 1.113
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$94.72changed to$92.41
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.50 changed to 1.49
- Malpractice RVU 0.10 changed to 0.12
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$93.17changed to$94.72
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$96.49changed to$93.17
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.47 changed to 1.50
- Work GPCI 1.056 changed to 1.057
- Practice expense GPCI 1.214 changed to 1.192
- Malpractice GPCI 1.231 changed to 1.168
January 1, 2023
RVU23A
$98.53changed to$96.49
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.44 changed to 1.47
- Work GPCI 1.054 changed to 1.056
- Practice expense GPCI 1.236 changed to 1.214
- Malpractice GPCI 1.294 changed to 1.231
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$96.76changed to$98.53
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.38 changed to 1.44
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$90.28changed to$96.76
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.19 changed to 1.38
- Malpractice RVU 0.09 changed to 0.10
- Work GPCI 1.049 changed to 1.054
- Practice expense GPCI 1.221 changed to 1.236
- Malpractice GPCI 1.277 changed to 1.294
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$86.27changed to$90.28
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.11 changed to 1.19
- Malpractice RVU 0.10 changed to 0.09
- Work GPCI 1.045 changed to 1.049
- Practice expense GPCI 1.205 changed to 1.221
- Malpractice GPCI 1.261 changed to 1.277
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$84.00changed to$86.27
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.06 changed to 1.11
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$84.31changed to$84.00
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.07 changed to 1.06
- Work GPCI 1.048 changed to 1.045
- Malpractice GPCI 1.271 changed to 1.261
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$83.81changed to$84.31
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.06 changed to 1.07
- Work GPCI 1.051 changed to 1.048
- Malpractice GPCI 1.280 changed to 1.271
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$84.11changed to$83.81
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$83.69changed to$84.11
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
No ratechanged to$83.69
Held through RVU15B.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $98.85 | $42.98 | RVU26D |
| 2026-07-01 | $98.85 | $42.98 | RVU26C |
| 2026-04-01 | $98.85 | $42.98 | RVU26B |
| 2026-01-01 | $98.85 | $42.98 | RVU26A |
| 2025-10-01 | $92.41 | $49.61 | RVU25D |
| 2025-07-01 | $92.41 | $49.61 | RVU25C |
| 2025-04-01 | $92.41 | $49.61 | RVU25B |
| 2025-01-01 | $92.41 | $49.61 | RVU25A |
| 2024-10-01 | $94.72 | $49.88 | RVU24D |
| 2024-07-01 | $94.72 | $49.88 | RVU24C |
| 2024-04-01 | $94.72 | $49.88 | RVU24B |
| 2024-03-09 | $94.72 | $49.88 | RVU24AR |
| 2024-01-01 | $93.17 | $49.07 | RVU24A |
| 2023-10-01 | $96.49 | $51.24 | RVU23D |
| 2023-07-01 | $96.49 | $51.24 | RVU23C |
| 2023-04-01 | $96.49 | $51.24 | RVU23B |
| 2023-01-01 | $96.49 | $51.24 | RVU23A |
| 2022-10-01 | $98.53 | $52.34 | RVU22D |
| 2022-07-01 | $98.53 | $52.34 | RVU22C |
| 2022-04-01 | $98.53 | $52.34 | RVU22B |
| 2022-01-01 | $98.53 | $52.34 | RVU22A |
| 2021-10-01 | $96.76 | $52.77 | RVU21D |
| 2021-07-01 | $96.76 | $52.77 | RVU21C |
| 2021-04-01 | $96.76 | $52.77 | RVU21B |
| 2021-01-01 | $96.76 | $52.77 | RVU21A |
| 2020-10-01 | $90.28 | $52.82 | RVU20D |
| 2020-07-01 | $90.28 | $52.82 | RVU20C |
| 2020-04-01 | $90.28 | $52.82 | RVU20B |
| 2020-01-01 | $90.28 | $52.82 | RVU20A |
| 2019-10-01 | $86.27 | $53.26 | RVU19D |
| 2019-07-01 | $86.27 | $53.26 | RVU19C |
| 2019-04-01 | $86.27 | $53.26 | RVU19B |
| 2019-01-01 | $86.27 | $53.26 | RVU19A |
| 2018-10-01 | $84.00 | $52.77 | RVU18D |
| 2018-07-01 | $84.00 | $52.77 | RVU18C |
| 2018-04-01 | $84.00 | $52.77 | RVU18B |
| 2018-01-01 | $84.00 | $52.77 | RVU18AR1 |
| 2017-10-01 | $84.31 | $53.17 | RVU17D |
| 2017-07-01 | $84.31 | $53.17 | RVU17C |
| 2017-04-01 | $84.31 | $53.17 | RVU17B |
| 2017-01-01 | $84.31 | $53.17 | RVU17A |
| 2016-10-01 | $83.81 | $52.31 | RVU16D |
| 2016-07-01 | $83.81 | $52.31 | RVU16C |
| 2016-04-01 | $83.81 | $52.31 | RVU16B |
| 2016-01-01 | $83.81 | $52.31 | RVU16A |
| 2015-10-01 | $84.11 | $52.50 | RVU15D |
| 2015-07-01 | $84.11 | $52.50 | RVU15C |
| 2015-04-01 | $83.69 | $52.24 | RVU15B |
| 2015-01-01 | $83.69 | $52.24 | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Washington, DC area rate applies
Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.
- Washington
20604 billing questions
How does this differ from 20600?
Both codes address a small joint or bursa. Report 20604 when ultrasound guidance is used and permanently recorded and reported; 20600 is the counterpart without ultrasound guidance.
Can ultrasound guidance be billed separately?
The ultrasound guidance, permanent recording, and reporting are included in 20604. Do not separately report guidance for the same aspiration or injection.
Which joint-size code applies to a wrist injection?
The wrist is an intermediate joint, not a small joint. Use the code matching the intermediate-joint service and whether ultrasound guidance was used.
What documentation supports 20604?
Document the specific small joint or bursa, the aspiration or injection performed, and ultrasound guidance with permanent image recording and reporting.
How is bilateral treatment paid?
When the bilateral procedure is reported with modifier 50, CMS pays 150%.
What happens when this is performed with another procedure?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures in the same session are paid at 50%.
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
Fee sheets
Put 20604 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet