CPT code 20604: Joint aspiration or injection, small joint or bursa2026 Medicare rate & RVUs in Guam
Report this service when a clinician aspirates fluid from or injects a small joint or bursa using ultrasound guidance with permanent image recording.
Medicare pays $93.09 for 20604 in the office in Guam (Hawaii, Guam, HI). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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.
20604 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | $93.09 | $39.16 |
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.
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).
20604 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 20600Joint aspiration/injectionSmall joint, without ultrasound
- Use 20600 for a small-joint or bursa aspiration or injection without ultrasound guidance. 20604 includes ultrasound guidance with permanent recording and reporting.
- 20606Joint aspirationIntermediate joint, ultrasound-guided
- Both include ultrasound guidance, but 20606 is for an intermediate joint or bursa; 20604 is for a small joint or bursa.
- 20611Joint aspiration/injectionUltrasound-guided major joint or bursa
- Both include ultrasound guidance, but 20611 is for a major joint or bursa; 20604 is for a small joint or bursa.
- 20612Ganglion treatmentAspiration and/or injection
- 20612 addresses aspiration or injection of a ganglion cyst. Use 20604 for a small joint or bursa rather than a ganglion cyst.
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
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