CPT code 20606: Joint aspiration, intermediate joint, ultrasound-guided2026 Medicare rate & RVUs in Montana
Reports aspiration, injection, or both for an intermediate joint or bursa when ultrasound guides needle placement and the images are recorded and reported.
In Montana, Medicare pays $94.18 for 20606 in the office and $44.75 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 20606 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 20606 covers
This service covers needle aspiration, injection, or both in an intermediate joint or bursa with ultrasound guidance. Typical sites include the wrist, elbow, ankle, acromioclavicular joint, temporomandibular joint, and olecranon bursa. Orthopedic clinicians, rheumatologists, and other qualified practitioners commonly perform it in an office or outpatient setting. The ultrasound guidance, image recording, and reporting are part of the service.
Select the code by the joint or bursa’s size and whether ultrasound guidance is used: this code is for an intermediate site with ultrasound, not a small or major site. The record should identify the treated site, the aspiration or injection performed, and the ultrasound guidance and image documentation. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 identifies a bilateral procedure, which CMS pays at 150%. Assistant-at-surgery payment is restricted; 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 Montana compares for 20606
Across 109 of 109 payment localities, the office rate for 20606 runs from $84.15 in Arkansas to $121.32 in San Benito County, CA. Montana pays $94.18. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$94.18
- Los Angeles, CA · California$104.70+$10.52
- Washington, DC area · District of Columbia$106.64+$12.46
- Miami, FL · Florida$102.67+$8.49
- Chicago, IL · Illinois$99.90+$5.72
- Manhattan, NY · New York$107.94+$13.76
- Alaska · Alaska$112.49+$18.31
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $85.27 | $42.02 |
| ArkansasArkansas | $84.15 | $41.68 |
| ArizonaArizona | $91.83 | $43.93 |
| Bakersfield, CACalifornia | $98.76 | $44.58 |
| Chico, CACalifornia | $98.40 | $44.22 |
| El Centro, CACalifornia | $98.42 | $44.24 |
| Fresno, CACalifornia | $98.40 | $44.22 |
| Hanford, CACalifornia | $98.40 | $44.22 |
| Madera, CACalifornia | $98.40 | $44.22 |
| Merced, CACalifornia | $98.40 | $44.22 |
| Modesto, CACalifornia | $98.40 | $44.22 |
| Napa, CACalifornia | $112.55 | $47.40 |
| Oxnard, CACalifornia | $104.05 | $45.62 |
| Redding, CACalifornia | $98.40 | $44.22 |
| Rest of CaliforniaCalifornia | $98.40 | $44.22 |
| Riverside, CACalifornia | $99.71 | $45.53 |
| Sacramento, CACalifornia | $102.87 | $45.38 |
| Salinas, CACalifornia | $102.48 | $45.19 |
| San Diego, CACalifornia | $104.60 | $45.47 |
| Marin County, CACalifornia | $118.69 | $48.99 |
| San Francisco, CACalifornia | $118.55 | $48.85 |
| San Benito County, CACalifornia | $121.32 | $50.04 |
| Santa Clara County, CACalifornia | $120.77 | $49.48 |
| San Luis Obispo, CACalifornia | $100.87 | $44.57 |
| Santa Cruz, CACalifornia | $105.37 | $45.31 |
| Santa Maria, CACalifornia | $102.78 | $45.14 |
| Santa Rosa, CACalifornia | $106.41 | $45.71 |
| Stockton, CACalifornia | $98.40 | $44.22 |
| Vallejo, CACalifornia | $112.35 | $47.20 |
| Visalia, CACalifornia | $98.40 | $44.22 |
| Yuba City, CACalifornia | $98.40 | $44.22 |
| ColoradoColorado | $97.38 | $44.79 |
| ConnecticutConnecticut | $100.11 | $46.87 |
| DelawareDelaware | $93.26 | $44.42 |
| Fort Lauderdale, FLFlorida | $98.18 | $48.10 |
| Rest of FloridaFlorida | $93.68 | $46.42 |
| Atlanta, GAGeorgia | $96.01 | $45.79 |
| Rest of GeorgiaGeorgia | $88.76 | $44.66 |
| Hawaii, Guam, HIHawaii | $100.37 | $44.17 |
| IowaIowa | $86.89 | $41.66 |
| IdahoIdaho | $87.48 | $42.00 |
| East St. Louis, ILIllinois | $93.66 | $48.18 |
| Rest of IllinoisIllinois | $91.45 | $46.32 |
| Suburban Chicago, ILIllinois | $99.07 | $48.30 |
| IndianaIndiana | $87.94 | $42.11 |
| KansasKansas | $86.69 | $42.00 |
| KentuckyKentucky | $87.47 | $43.53 |
| New Orleans, LALouisiana | $91.35 | $44.83 |
| Rest of LouisianaLouisiana | $87.42 | $43.67 |
| Metropolitan Boston, MAMassachusetts | $106.24 | $47.21 |
| Rest of MassachusettsMassachusetts | $96.95 | $44.89 |
| Baltimore area, MDMaryland | $99.86 | $46.82 |
| Rest of MarylandMaryland | $94.88 | $44.85 |
| Rest of MaineMaine | $88.08 | $42.60 |
| Southern Maine, MEMaine | $92.19 | $43.21 |
| Detroit, MIMichigan | $94.93 | $47.23 |
| Rest of MichiganMichigan | $89.71 | $44.58 |
| MinnesotaMinnesota | $93.03 | $42.17 |
| Metropolitan Kansas City, MOMissouri | $90.59 | $44.18 |
| Metropolitan St. Louis, MOMissouri | $91.44 | $44.38 |
| Rest of MissouriMissouri | $86.16 | $43.55 |
| MississippiMississippi | $85.16 | $42.60 |
| North CarolinaNorth Carolina | $88.89 | $42.77 |
| North DakotaNorth Dakota | $91.81 | $42.38 |
| NebraskaNebraska | $87.27 | $41.65 |
| New HampshireNew Hampshire | $96.04 | $44.58 |
| Northern New JerseyNew Jersey | $105.72 | $48.37 |
| Rest of New JerseyNew Jersey | $101.17 | $47.19 |
| New MexicoNew Mexico | $90.23 | $44.90 |
| NevadaNevada | $93.58 | $44.10 |
| NYC suburbs and Long Island, NYNew York | $110.58 | $51.80 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $101.96 | $47.83 |
| Queens, NYNew York | $108.51 | $50.08 |
| Rest of New YorkNew York | $90.13 | $43.17 |
| OhioOhio | $89.22 | $44.09 |
| OklahomaOklahoma | $87.15 | $43.01 |
| Portland, OROregon | $100.07 | $45.14 |
| Rest of OregonOregon | $92.77 | $43.53 |
| Metropolitan Philadelphia, PAPennsylvania | $97.91 | $46.45 |
| Rest of PennsylvaniaPennsylvania | $89.26 | $43.88 |
| Puerto RicoPuerto Rico | $94.76 | $44.79 |
| Rhode IslandRhode Island | $96.28 | $45.21 |
| South CarolinaSouth Carolina | $89.22 | $43.55 |
| South DakotaSouth Dakota | $91.53 | $42.10 |
| TennesseeTennessee | $87.11 | $42.17 |
| Austin, TXTexas | $97.13 | $44.83 |
| Beaumont, TXTexas | $88.74 | $43.75 |
| Brazoria, TXTexas | $93.05 | $44.07 |
| Dallas, TXTexas | $93.69 | $44.45 |
| Fort Worth, TXTexas | $93.16 | $44.42 |
| Galveston, TXTexas | $93.36 | $44.27 |
| Houston, TXTexas | $95.56 | $46.47 |
| Rest of TexasTexas | $90.87 | $43.96 |
| UtahUtah | $90.33 | $43.87 |
| VirginiaVirginia | $92.04 | $43.44 |
| Virgin Islands, VIUnited States Virgin Islands | $94.76 | $44.79 |
| VermontVermont | $91.64 | $42.70 |
| Rest of WashingtonWashington | $96.70 | $44.65 |
| King County, WAWashington | $108.13 | $47.48 |
| WisconsinWisconsin | $89.00 | $41.65 |
| West VirginiaWest Virginia | $88.39 | $45.43 |
| WyomingWyoming | $93.15 | $43.72 |
20606 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.
$84.15
$112.49
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 | $112.49 | 1 |
| AL | $85.27 | 1 |
| AR | $84.15 | 1 |
| AZ | $91.83 | 1 |
| CA | $98.40–$121.32 | 29 |
| CO | $97.38 | 1 |
| CT | $100.11 | 1 |
| DC | $106.64 | 1 |
| DE | $93.26 | 1 |
| FL | $93.68–$102.67 | 3 |
| GA | $88.76–$96.01 | 2 |
| GU | $100.37 | 1 |
| HI | $100.37 | 1 |
| IA | $86.89 | 1 |
| ID | $87.48 | 1 |
| IL | $91.45–$99.90 | 4 |
| IN | $87.94 | 1 |
| KS | $86.69 | 1 |
| KY | $87.47 | 1 |
| LA | $87.42–$91.35 | 2 |
| MA | $96.95–$106.24 | 2 |
| MD | $94.88–$106.64 | 3 |
| ME | $88.08–$92.19 | 2 |
| MI | $89.71–$94.93 | 2 |
| MN | $93.03 | 1 |
| MO | $86.16–$91.44 | 3 |
| MS | $85.16 | 1 |
| MT | $94.18 | 1 |
| NC | $88.89 | 1 |
| ND | $91.81 | 1 |
| NE | $87.27 | 1 |
| NH | $96.04 | 1 |
| NJ | $101.17–$105.72 | 2 |
| NM | $90.23 | 1 |
| NV | $93.58 | 1 |
| NY | $90.13–$110.58 | 5 |
| OH | $89.22 | 1 |
| OK | $87.15 | 1 |
| OR | $92.77–$100.07 | 2 |
| PA | $89.26–$97.91 | 2 |
| PR | $94.76 | 1 |
| RI | $96.28 | 1 |
| SC | $89.22 | 1 |
| SD | $91.53 | 1 |
| TN | $87.11 | 1 |
| TX | $88.74–$97.13 | 8 |
| UT | $90.33 | 1 |
| VA | $92.04–$106.64 | 2 |
| VI | $94.76 | 1 |
| VT | $91.64 | 1 |
| WA | $96.70–$108.13 | 2 |
| WI | $89.00 | 1 |
| WV | $88.39 | 1 |
| WY | $93.15 | 1 |
How the 20606 rate is calculated
Each of 20606’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 · 20606
RVUs × geographic indexes × conversion factor
Work0.98
0.98 RVUs× 1.000 GPCI
Practice expense1.72
1.72 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
2.8200
Conversion factor
$33.4009
Medicare rate
$94.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,769
- Code
- 20606
- Physician work
- 0.98
- Practice expense
- 1.72
- Malpractice
- 0.12
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.98 | × 1.000 | 0.9800 |
| Practice expense | 1.72 | × 1.000 | 1.7200 |
| Malpractice | 0.12 | × 0.998 | 0.1198 |
| Total RVUs | 2.8198 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$94.18
Office: (0.98 × 1 + 1.72 × 1 + 0.12 × 0.998) × $33.4009 = $94.18
Facility: (0.98 × 1 + 0.24 × 1 + 0.12 × 0.998) × $33.4009 = $44.75
Payment rules and modifiers for 20606
The CMS indicators that decide how 20606 is paid alongside other services.
CMS payment indicators · 20606
Joint aspiration, intermediate joint, ultrasound-guided
| 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
20606 without 50 · national office
$94.19
Joint aspiration, intermediate joint, ultrasound-guided
20606-50 · Bilateral: 150%
$141.29
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 20606 has changed in Montana
20606 · Office / nonfacility
$94.18
Effective 2026-10-01
The base rate is $6.94 higher than on 2025-10-01, moving from $87.24 to $94.18 (8.0%).
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
$87.24changed to$94.18
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.00 changed to 0.98
- Practice expense RVU 1.57 changed to 1.72
- Malpractice RVU 0.13 changed to 0.12
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$90.11changed to$87.24
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.58 changed to 1.57
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$88.64changed to$90.11
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$90.39changed to$88.64
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.55 changed to 1.58
- Malpractice RVU 0.12 changed to 0.13
January 1, 2023
RVU23A
$91.27changed to$90.39
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.53 changed to 1.55
- Malpractice RVU 0.11 changed to 0.12
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$90.62changed to$91.27
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.47 changed to 1.53
- Malpractice RVU 0.13 changed to 0.11
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$87.82changed to$90.62
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.29 changed to 1.47
- Malpractice RVU 0.11 changed to 0.13
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$86.34changed to$87.82
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.20 changed to 1.29
- Malpractice RVU 0.12 changed to 0.11
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$84.80changed to$86.34
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.16 changed to 1.20
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$83.67changed to$84.80
- Conversion factor 35.8887 changed to 35.9996
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$82.25changed to$83.67
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.15 changed to 1.16
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$82.54changed to$82.25
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$82.13changed to$82.54
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
No ratechanged to$82.13
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 | $94.18 | $44.75 | RVU26D |
| 2026-07-01 | $94.18 | $44.75 | RVU26C |
| 2026-04-01 | $94.18 | $44.75 | RVU26B |
| 2026-01-01 | $94.18 | $44.75 | RVU26A |
| 2025-10-01 | $87.24 | $50.37 | RVU25D |
| 2025-07-01 | $87.24 | $50.37 | RVU25C |
| 2025-04-01 | $87.24 | $50.37 | RVU25B |
| 2025-01-01 | $87.24 | $50.37 | RVU25A |
| 2024-10-01 | $90.11 | $51.50 | RVU24D |
| 2024-07-01 | $90.11 | $51.50 | RVU24C |
| 2024-04-01 | $90.11 | $51.50 | RVU24B |
| 2024-03-09 | $90.11 | $51.50 | RVU24AR |
| 2024-01-01 | $88.64 | $50.66 | RVU24A |
| 2023-10-01 | $90.39 | $52.10 | RVU23D |
| 2023-07-01 | $90.39 | $52.10 | RVU23C |
| 2023-04-01 | $90.39 | $52.10 | RVU23B |
| 2023-01-01 | $90.39 | $52.10 | RVU23A |
| 2022-10-01 | $91.27 | $52.51 | RVU22D |
| 2022-07-01 | $91.27 | $52.51 | RVU22C |
| 2022-04-01 | $91.27 | $52.51 | RVU22B |
| 2022-01-01 | $91.27 | $52.51 | RVU22A |
| 2021-10-01 | $90.62 | $53.98 | RVU21D |
| 2021-07-01 | $90.62 | $53.98 | RVU21C |
| 2021-04-01 | $90.62 | $53.98 | RVU21B |
| 2021-01-01 | $90.62 | $53.98 | RVU21A |
| 2020-10-01 | $87.82 | $56.06 | RVU20D |
| 2020-07-01 | $87.82 | $56.06 | RVU20C |
| 2020-04-01 | $87.82 | $56.06 | RVU20B |
| 2020-01-01 | $87.82 | $56.06 | RVU20A |
| 2019-10-01 | $86.34 | $57.87 | RVU19D |
| 2019-07-01 | $86.34 | $57.87 | RVU19C |
| 2019-04-01 | $86.34 | $57.87 | RVU19B |
| 2019-01-01 | $86.34 | $57.87 | RVU19A |
| 2018-10-01 | $84.80 | $57.81 | RVU18D |
| 2018-07-01 | $84.80 | $57.81 | RVU18C |
| 2018-04-01 | $84.80 | $57.81 | RVU18B |
| 2018-01-01 | $84.80 | $57.81 | RVU18AR1 |
| 2017-10-01 | $83.67 | $56.40 | RVU17D |
| 2017-07-01 | $83.67 | $56.40 | RVU17C |
| 2017-04-01 | $83.67 | $56.40 | RVU17B |
| 2017-01-01 | $83.67 | $56.40 | RVU17A |
| 2016-10-01 | $82.25 | $55.04 | RVU16D |
| 2016-07-01 | $82.25 | $55.04 | RVU16C |
| 2016-04-01 | $82.25 | $55.04 | RVU16B |
| 2016-01-01 | $82.25 | $55.04 | RVU16A |
| 2015-10-01 | $82.54 | $55.23 | RVU15D |
| 2015-07-01 | $82.54 | $55.23 | RVU15C |
| 2015-04-01 | $82.13 | $54.96 | RVU15B |
| 2015-01-01 | $82.13 | $54.96 | 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 Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
20606 billing questions
How is 20606 different from 20605?
Both apply to an intermediate joint or bursa, but 20606 includes ultrasound guidance with image recording and reporting. Use 20605 when the intermediate-site procedure is performed without ultrasound guidance.
Which sites are considered intermediate for this code?
Common examples include the wrist, elbow, ankle, acromioclavicular joint, temporomandibular joint, and olecranon bursa. Choose the code based on the treated anatomy and whether ultrasound guidance is used.
Can ultrasound guidance be billed separately?
The ultrasound guidance, image recording, and reporting are included in 20606. Document the guidance and images, but do not separately report ultrasound guidance for this same procedure.
What documentation supports 20606?
Record the specific joint or bursa, whether aspiration, injection, or both were performed, and the use of ultrasound guidance. Retain the required image recording and report.
How is a bilateral procedure reported?
CMS identifies 20606 as bilateral when reported with modifier 50 and pays it at 150%. The medical record should support treatment of the corresponding site on both sides.
What happens when 20606 is performed with another procedure?
For multiple procedures in the same session, CMS pays the highest-valued procedure in full and the other procedures at 50%. Same-day preoperative and postoperative care is included in 20606’s 0-day global period.
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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