CPT code 20610: Joint injection, major joint or bursa, no ultrasound2026 Medicare rate & RVUs in Iowa

Needle aspiration of fluid from, or injection of medication into, a large joint or bursa such as the knee, shoulder, or hip, performed without ultrasound guidance.

CMS RVU26DEffective Oct 1, 2026One payment locality4.8M Medicare services in 2024

In Iowa, Medicare pays $62.89 for 20610 in the office and $36.31 when it’s performed in a hospital or facility.

$62.89Office (non-facility)
$36.31Hospital or facility
−8.6%vs the national office rate ($68.81)

Check a contract rate as a % of Medicare · 20610 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 20610 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Iowa
  2. What 20610 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 20610 covers

Code 20610 covers needle aspiration, injection, or both in a major joint or bursa, including the knee, glenohumeral joint, hip, subacromial bursa, and trochanteric bursa. A clinician may drain a knee effusion for cell count or crystal testing or inject medication into a painful joint or bursa. Orthopedists, rheumatologists, sports medicine and primary care clinicians, and advanced practice providers commonly perform it in offices. They may use palpable landmarks or separately reportable non-ultrasound imaging guidance.

Report one unit for each distinct major joint or bursa treated in a session; aspiration followed by injection of the same site remains one unit. Document the target and side, procedure performed, aspirated fluid when applicable, and injected drug and dose. Report separately payable, provider-supplied drugs with the appropriate HCPCS code and administered units. CMS assigns a 0-day global period that includes same-day preoperative and postoperative care; a significant, separately identifiable E/M requires modifier 25 on the E/M code. For multiple procedures in one session, CMS pays the highest-valued in full and others at 50%; bilateral procedures reported with modifier 50 pay at 150%. CMS does not pay an assistant at surgery or permit co-surgeons or team surgery for this code.

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 Iowa compares for 20610

Across 109 of 109 payment localities, the office rate for 20610 runs from $61.24 in Arkansas to $86.75 in San Benito County, CA. Iowa pays $62.89. The RVUs are the same everywhere; the geographic indexes change the dollars.

20610 in Iowa vs other payment areas
  1. Iowa · this page$62.89
  2. Los Angeles, CA · California$75.49+$12.60
  3. Washington, DC area · District of Columbia$77.58+$14.69
  4. Miami, FL · Florida$77.03+$14.14
  5. Chicago, IL · Illinois$74.80+$11.91
  6. Manhattan, NY · New York$79.27+$16.38
  7. Alaska · Alaska$82.23+$19.34

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

Every other payment area

20610 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$62.08$36.65
ArkansasArkansas$61.24$36.28
ArizonaArizona$66.98$38.82
Bakersfield, CACalifornia$71.32$39.47
Chico, CACalifornia$70.95$39.10
El Centro, CACalifornia$70.97$39.12
Fresno, CACalifornia$70.95$39.10
Hanford, CACalifornia$70.95$39.10

20610 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.

$61.24

$82.23

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
20610 office rate range by state
State / territoryOffice rate rangeLocalities
AK$82.231
AL$62.081
AR$61.241
AZ$66.981
CA$70.95–$86.7529
CO$70.641
CT$73.221
DC$77.581
DE$68.031
FL$69.29–$77.033
GA$65.46–$70.382
GU$72.291
HI$72.291
IA$62.891
ID$63.421
IL$67.88–$74.804
IN$63.751
KS$62.931
KY$64.141
LA$64.17–$67.112
MA$70.39–$76.902
MD$69.17–$77.583
ME$64.06–$66.852
MI$66.00–$70.432
MN$66.871
MO$63.35–$66.953
MS$62.291
MT$68.801
NC$64.641
ND$66.231
NE$63.121
NH$69.851
NJ$73.82–$76.922
NM$66.461
NV$68.121
NY$65.58–$81.505
OH$65.471
OK$63.691
OR$67.36–$72.412
PA$65.39–$71.702
PR$69.171
RI$70.101
SC$65.211
SD$65.921
TN$63.271
TX$65.01–$70.618
UT$66.041
VA$66.87–$77.582
VI$69.171
VT$66.271
WA$70.16–$78.092
WI$64.171
WV$65.601
WY$67.681

See 20610 in every payment locality

How the 20610 rate is calculated

Each of 20610’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 · 20610

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.77

0.77 RVUs× 1.000 GPCI

Practice expense1.16

1.16 RVUs× 1.000 GPCI

Malpractice0.13

0.13 RVUs× 1.000 GPCI

Adjusted RVUs

2.0600

Conversion factor

$33.4009

Medicare rate

$68.81

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Iowa inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,771

Code
20610
Physician work
0.77
Practice expense
1.16
Malpractice
0.13

GPCI2026.csv

53

Locality
Iowa
Physician work
1.000
Practice expense
0.915
Malpractice
0.397
Office calculation for 20610 in Iowa
ComponentRVULocality factorAdjusted
Physician work0.77× 1.0000.7700
Practice expense1.16× 0.9151.0614
Malpractice0.13× 0.3970.0516
Total RVUs1.8830
Conversion factor× 33.4009

Office rate, Iowa$62.89

Office: (0.77 × 1 + 1.16 × 0.915 + 0.13 × 0.397) × $33.4009 = $62.89

Facility: (0.77 × 1 + 0.29 × 0.915 + 0.13 × 0.397) × $33.4009 = $36.31

Open 20610 in the RVU calculator

Payment rules and modifiers for 20610

The CMS indicators that decide how 20610 is paid alongside other services.

CMS payment indicators · 20610

Joint injection, major joint or bursa, no 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

20610 without 50 · national office

$68.81

Joint injection, major joint or bursa, no ultrasound

20610-50 · Bilateral: 150%

$103.22

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 20610 has changed in Iowa

20610 · Office / nonfacility

$62.89

Effective 2026-10-01

The base rate is $4.70 higher than on 2025-10-01, moving from $58.19 to $62.89 (8.1%).

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

    $58.19changed to$62.89

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.79 changed to 0.77
    • Practice expense RVU 1.04 changed to 1.16
    • Practice expense GPCI 0.913 changed to 0.915
    • Malpractice GPCI 0.457 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $59.88changed to$58.19

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $58.90changed to$59.88

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $60.02changed to$58.90

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.02 changed to 1.04
    • Malpractice RVU 0.12 changed to 0.13
    • Practice expense GPCI 0.910 changed to 0.913
    • Malpractice GPCI 0.441 changed to 0.457
  5. January 1, 2023

    RVU23A

    $60.81changed to$60.02

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.01 changed to 1.02
    • Practice expense GPCI 0.907 changed to 0.910
    • Malpractice GPCI 0.425 changed to 0.441

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $59.88changed to$60.81

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 0.96 changed to 1.01
    • Malpractice RVU 0.13 changed to 0.12

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $58.50changed to$59.88

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.86 changed to 0.96
    • Malpractice RVU 0.12 changed to 0.13
    • Malpractice GPCI 0.424 changed to 0.425

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $56.45changed to$58.50

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 0.80 changed to 0.86
    • Malpractice GPCI 0.423 changed to 0.424

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $56.71changed to$56.45

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 0.81 changed to 0.80

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $56.55changed to$56.71

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense GPCI 0.902 changed to 0.907
    • Malpractice GPCI 0.458 changed to 0.423

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $56.07changed to$56.55

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 0.80 changed to 0.81
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 0.493 changed to 0.458

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $56.42changed to$56.07

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 0.81 changed to 0.80
    • Malpractice RVU 0.11 changed to 0.12

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $56.13changed to$56.42

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $55.73changed to$56.13

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 0.80 changed to 0.81
    • Practice expense GPCI 0.892 changed to 0.896
    • Malpractice GPCI 0.475 changed to 0.493

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $55.00changed to$55.73

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.87 changed to 0.80
    • Malpractice RVU 0.12 changed to 0.11
    • Practice expense GPCI 0.887 changed to 0.892
    • Malpractice GPCI 0.456 changed to 0.475

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $55.00

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$62.89$36.31RVU26D
2026-07-01$62.89$36.31RVU26C
2026-04-01$62.89$36.31RVU26B
2026-01-01$62.89$36.31RVU26A
2025-10-01$58.19$40.47RVU25D
2025-07-01$58.19$40.47RVU25C
2025-04-01$58.19$40.47RVU25B
2025-01-01$58.19$40.47RVU25A
2024-10-01$59.88$41.65RVU24D
2024-07-01$59.88$41.65RVU24C
2024-04-01$59.88$41.65RVU24B
2024-03-09$59.88$41.65RVU24AR
2024-01-01$58.90$40.97RVU24A
2023-10-01$60.02$41.82RVU23D
2023-07-01$60.02$41.82RVU23C
2023-04-01$60.02$41.82RVU23B
2023-01-01$60.02$41.82RVU23A
2022-10-01$60.81$42.29RVU22D
2022-07-01$60.81$42.29RVU22C
2022-04-01$60.81$42.29RVU22B
2022-01-01$60.81$42.29RVU22A
2021-10-01$59.88$42.79RVU21D
2021-07-01$59.88$42.79RVU21C
2021-04-01$59.88$42.79RVU21B
2021-01-01$59.88$42.79RVU21A
2020-10-01$58.50$43.77RVU20D
2020-07-01$58.50$43.77RVU20C
2020-04-01$58.50$43.77RVU20B
2020-01-01$58.50$43.77RVU20A
2019-10-01$56.45$43.70RVU19D
2019-07-01$56.45$43.70RVU19C
2019-04-01$56.45$43.70RVU19B
2019-01-01$56.45$43.70RVU19A
2018-10-01$56.71$43.98RVU18D
2018-07-01$56.71$43.98RVU18C
2018-04-01$56.71$43.98RVU18B
2018-01-01$56.71$43.98RVU18AR1
2017-10-01$56.55$43.92RVU17D
2017-07-01$56.55$43.92RVU17C
2017-04-01$56.55$43.92RVU17B
2017-01-01$56.55$43.92RVU17A
2016-10-01$56.07$43.56RVU16D
2016-07-01$56.07$43.56RVU16C
2016-04-01$56.07$43.56RVU16B
2016-01-01$56.07$43.56RVU16A
2015-10-01$56.42$43.86RVU15D
2015-07-01$56.42$43.86RVU15C
2015-04-01$56.13$43.64RVU15B
2015-01-01$56.13$43.64RVU15A
2014-10-01$55.73$43.59RVU14D
2014-07-01$55.73$43.59RVU14C
2014-04-01$55.73$43.59RVU14B
2014-01-01$55.73$43.59RVU14A
2013-10-01$55.00$42.02RVU13D
2013-07-01$55.00$42.02RVU13C
2013-04-01$55.00$42.02RVU13B
2013-01-01$55.00$42.02RVU13AR

Price 20610 for an earlier date of service

Where the Iowa rate applies

Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Iowa

20610 billing questions

Which joints qualify for 20610 rather than 20605 or 20600?

20610 is for major joints and bursae such as the knee, shoulder, hip, and subacromial bursa. Intermediate sites like the wrist, elbow, ankle, and olecranon bursa go to 20605, and small joints of the fingers and toes go to 20600.

If the knee is aspirated and then injected in the same session, is that two units?

No. Aspiration and injection of the same joint in one session are one unit of 20610, even if separate needle passes are needed.

How are bilateral knee injections reported to Medicare?

Report 20610 with modifier 50 on one line with one unit; CMS pays bilateral procedures at 150%. For a knee and a shoulder treated in the same session, report both sites; the multiple-procedure reduction applies, and a distinct-site modifier is used only when needed to identify separately reportable services.

Can an office visit be billed on the same day?

Yes, when the provider performs a significant, separately identifiable evaluation beyond the usual pre-injection assessment; append modifier 25 to the E/M code. The decision to inject and the brief assessment of the treated joint are included in the 0-day global.

What if imaging guidance is used?

If ultrasound guidance includes permanently recorded images and a written report, report 20611 instead of 20610; do not add 76942. For fluoroscopic needle guidance, report 20610 with the appropriate guidance code, such as 77002.

Is the injected drug included?

An eligible, provider-supplied corticosteroid or hyaluronan product may be reported separately with its HCPCS drug code and units based on the administered dose. Local anesthetic used for the procedure is not separately billed.

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 20610PPRRVU2026_Oct_nonQPP.csv, line 1,771 (RVU26D)
Geographic factors for IowaGPCI2026.csv, line 53 (RVU26D)

Open CMS sourceHow we calculate rates

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