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CPT code 20650: Skeletal traction, bone pin insertion2026 Medicare rate & RVUs in Houston, TX

Reports placement of a wire or pin into bone to establish skeletal traction, such as temporary traction for selected fractures, including pin removal when performed.

CMS RVU26DEffective Oct 1, 2026One payment locality894 Medicare services in 2024

In Houston, TX, Medicare pays $253.73 for 20650 in the office and $164.84 when it’s performed in a hospital or facility.

$253.73Office (non-facility)
$164.84Hospital or facility
+1.7%vs the national office rate ($249.50)

Check a contract rate as a % of Medicare · 20650 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 20650 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Houston, TX
  2. What 20650 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 20650 covers

An orthopedic surgeon places a wire or pin through bone and connects it to a traction setup to apply controlled pulling force. A typical use is temporary skeletal traction during management of a fracture when traction through a pin is needed. The service may be performed in a hospital or another setting where the clinician can place and manage the traction apparatus. The code includes removal of the traction wire or pin when performed.

Report the service when documentation identifies the bone and insertion site, the clinical reason for skeletal traction, and the pin or wire placement and traction application. The 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation, and team surgery is 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 20650

Across 109 of 109 payment localities, the office rate for 20650 runs from $220.41 in Arkansas to $323.67 in San Benito County, CA. Houston, TX pays $253.73. The RVUs are the same everywhere; the geographic indexes change the dollars.

20650 in Houston, TX vs other payment areas
  1. Houston, TX · this page$253.73
  2. Austin, TX · Texas$257.64+$3.91
  3. Beaumont, TX · Texas$233.96−$19.77
  4. Brazoria, TX · Texas$245.84−$7.89
  5. Dallas, TX · Texas$247.72−$6.01
  6. Fort Worth, TX · Texas$246.26−$7.47
  7. Galveston, TX · Texas$246.78−$6.95

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

Every other payment area

20650 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$239.98$155.03
Los Angeles, CACalifornia$278.05$172.15
Washington, DC areaDistrict of Columbia$283.90$178.45
Miami, FLFlorida$275.58$182.40
Chicago, ILIllinois$267.27$177.31
Manhattan, NYNew York$288.04$184.02
AlaskaAlaska$291.45$196.12
AlabamaAlabama$223.66$145.34

20650 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$220.41

$292.08

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

View every state and territory as a table
20650 office rate range by state
State / territoryOffice rate rangeLocalities
AK$291.451
AL$223.661
AR$220.411
AZ$242.631
CA$260.49–$323.6729
CO$258.031
CT$266.181
DC$283.901
DE$246.641
FL$248.73–$275.583
GA$234.37–$254.882
GU$266.451
HI$266.451
IA$228.021
ID$229.801
IL$242.50–$267.274
IN$231.111
KS$227.591
KY$230.371
LA$230.27–$241.632
MA$256.74–$282.712
MD$251.16–$283.903
ME$231.69–$243.362
MI$236.99–$252.522
MN$245.291
MO$226.73–$241.723
MS$223.581
MT$249.481
NC$234.021
ND$241.971
NE$229.091
NH$254.591
NJ$268.67–$281.072
NM$238.551
NV$247.551
NY$237.60–$295.875
OH$235.451
OK$229.271
OR$245.08–$265.502
PA$235.47–$259.962
PR$251.101
RI$254.911
SC$235.241
SD$241.081
TN$228.831
TX$233.96–$257.648
UT$238.451
VA$243.01–$283.902
VI$251.101
VT$241.611
WA$256.06–$287.812
WI$233.891
WV$233.671
WY$246.201

See 20650 in every payment locality

How the 20650 rate is calculated

Each of 20650’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 · 20650

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.22

2.22 RVUs× 1.000 GPCI

Practice expense4.87

4.87 RVUs× 1.000 GPCI

Malpractice0.38

0.38 RVUs× 1.000 GPCI

Adjusted RVUs

7.4700

Conversion factor

$33.4009

Medicare rate

$249.50

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

1,775

Code
20650
Physician work
2.22
Practice expense
4.87
Malpractice
0.38

GPCI2026.csv

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 20650 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work2.22× 1.0082.2378
Practice expense4.87× 0.9934.8359
Malpractice0.38× 1.3760.5229
Total RVUs7.5965
Conversion factor× 33.4009

Office rate, Houston, TX$253.73

Office: (2.22 × 1.008 + 4.87 × 0.993 + 0.38 × 1.376) × $33.4009 = $253.73

Facility: (2.22 × 1.008 + 2.19 × 0.993 + 0.38 × 1.376) × $33.4009 = $164.84

Open 20650 in the RVU calculator

Payment rules and modifiers for 20650

20650 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 20650

Skeletal traction, bone pin insertion

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 20650

Skeletal traction, bone pin insertion

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

20650 without 51 · national office

$249.50

Skeletal traction, bone pin insertion

20650-51 · Second procedure: 50%

$124.75

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 20650

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 20650
CodeHow it relatesOffice range, Houston, TX
Used instead
20660Cranial traction, tongs or calipersCranial tongs or another cranial fixation device may establish traction using a different device.No office rate
20661Cranial halo, four-pin applicationA cranial halo is a different fixation approach for selected cervical conditions.No office rate
20690External fixation, unilateral, single-plane frameExternal fixation stabilizes a fracture with a frame rather than a traction pin.No office rate

How 20650 has changed in Houston, TX

20650 · Office / nonfacility

$253.73

Effective 2026-10-01

The base rate is $18.23 higher than on 2025-10-01, moving from $235.50 to $253.73 (7.7%).

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

    $235.50changed to$253.73

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.28 changed to 2.22
    • Practice expense RVU 4.42 changed to 4.87
    • 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

    $239.88changed to$235.50

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.36 changed to 4.42
    • Malpractice RVU 0.37 changed to 0.38

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $235.97changed to$239.88

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $236.30changed to$235.97

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.17 changed to 4.36
    • Malpractice RVU 0.35 changed to 0.37
    • 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

    $234.81changed to$236.30

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.01 changed to 4.17
    • Malpractice RVU 0.34 changed to 0.35
    • 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

    $230.03changed to$234.81

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.84 changed to 4.01
    • Malpractice RVU 0.32 changed to 0.34

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $223.13changed to$230.03

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.48 changed to 3.84
    • 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

    $221.14changed to$223.13

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.46 changed to 3.48
    • Malpractice RVU 0.33 changed to 0.32
    • 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

    $220.19changed to$221.14

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.45 changed to 3.46
    • Malpractice RVU 0.32 changed to 0.33

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $215.64changed to$220.19

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.35 changed to 3.45
    • 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

    $213.01changed to$215.64

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.31 changed to 3.35
    • Malpractice RVU 0.31 changed to 0.32
    • 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

    $212.69changed to$213.01

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.28 changed to 3.31

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $211.63changed to$212.69

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $208.05changed to$211.63

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.22 changed to 3.28
    • Malpractice RVU 0.28 changed to 0.31
    • 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

    $209.76changed to$208.05

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.59 changed to 3.22
    • Malpractice RVU 0.29 changed to 0.28
    • 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: $209.76

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$253.73$164.84RVU26D
2026-07-01$253.73$164.84RVU26C
2026-04-01$253.73$164.84RVU26B
2026-01-01$253.73$164.84RVU26A
2025-10-01$235.50$172.56RVU25D
2025-07-01$235.50$172.56RVU25C
2025-04-01$235.50$172.56RVU25B
2025-01-01$235.50$172.56RVU25A
2024-10-01$239.88$174.78RVU24D
2024-07-01$239.88$174.78RVU24C
2024-04-01$239.88$174.78RVU24B
2024-03-09$239.88$174.78RVU24AR
2024-01-01$235.97$171.92RVU24A
2023-10-01$236.30$170.88RVU23D
2023-07-01$236.30$170.88RVU23C
2023-04-01$236.30$170.88RVU23B
2023-01-01$236.30$170.88RVU23A
2022-10-01$234.81$168.22RVU22D
2022-07-01$234.81$168.22RVU22C
2022-04-01$234.81$168.22RVU22B
2022-01-01$234.81$168.22RVU22A
2021-10-01$230.03$165.40RVU21D
2021-07-01$230.03$165.40RVU21C
2021-04-01$230.03$165.40RVU21B
2021-01-01$230.03$165.40RVU21A
2020-10-01$223.13$166.44RVU20D
2020-07-01$223.13$166.44RVU20C
2020-04-01$223.13$166.44RVU20B
2020-01-01$223.13$166.44RVU20A
2019-10-01$221.14$166.79RVU19D
2019-07-01$221.14$166.79RVU19C
2019-04-01$221.14$166.79RVU19B
2019-01-01$221.14$166.79RVU19A
2018-10-01$220.19$165.91RVU18D
2018-07-01$220.19$165.91RVU18C
2018-04-01$220.19$165.91RVU18B
2018-01-01$220.19$165.91RVU18AR1
2017-10-01$215.64$164.22RVU17D
2017-07-01$215.64$164.22RVU17C
2017-04-01$215.64$164.22RVU17B
2017-01-01$215.64$164.22RVU17A
2016-10-01$213.01$162.22RVU16D
2016-07-01$213.01$162.22RVU16C
2016-04-01$213.01$162.22RVU16B
2016-01-01$213.01$162.22RVU16A
2015-10-01$212.69$162.44RVU15D
2015-07-01$212.69$162.44RVU15C
2015-04-01$211.63$161.64RVU15B
2015-01-01$211.63$161.64RVU15A
2014-10-01$208.05$158.78RVU14D
2014-07-01$208.05$158.78RVU14C
2014-04-01$208.05$158.78RVU14B
2014-01-01$208.05$158.78RVU14A
2013-10-01$209.76$156.92RVU13D
2013-07-01$209.76$156.92RVU13C
2013-04-01$209.76$156.92RVU13B
2013-01-01$209.76$156.92RVU13AR

Price 20650 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

20650 billing questions

How is 20650 different from cranial tongs or a halo?

20650 describes skeletal traction established with a wire or pin inserted into bone. Cranial tongs and halo services use different fixation devices and are reported with their respective codes.

Can pin removal be billed separately?

Removal of the traction wire or pin is included when performed as part of this service. The code does not describe removal of a separate, previously placed implant.

Should modifier 50 be appended for pins on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.

What documentation supports reporting 20650?

Record the indication for skeletal traction, the bone and insertion site, the wire or pin placement, and the traction applied. Document removal when it is performed.

How are other procedures in the same session paid?

Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures in that session are subject to the reduction. Related postoperative visits are included for 10 days.

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 20650PPRRVU2026_Oct_nonQPP.csv, line 1,775 (RVU26D)
Geographic factors for Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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