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CPT code 20650: Skeletal traction, bone pin insertion2026 Medicare rate & RVUs in West Virginia

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 West Virginia, Medicare pays $233.67 for 20650 in the office and $155.88 when it’s performed in a hospital or facility.

$233.67Office (non-facility)
$155.88Hospital or facility
−6.3%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 West Virginia
  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 West Virginia 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. West Virginia pays $233.67. The RVUs are the same everywhere; the geographic indexes change the dollars.

20650 in West Virginia vs other payment areas
  1. West Virginia · this page$233.67
  2. Los Angeles, CA · California$278.05+$44.38
  3. Washington, DC area · District of Columbia$283.90+$50.23
  4. Miami, FL · Florida$275.58+$41.91
  5. Chicago, IL · Illinois$267.27+$33.60
  6. Manhattan, NY · New York$288.04+$54.37
  7. Alaska · Alaska$291.45+$57.78

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

Every other payment area

20650 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$223.66$145.34
ArkansasArkansas$220.41$143.52
ArizonaArizona$242.63$155.90
Bakersfield, CACalifornia$261.57$163.46
Chico, CACalifornia$260.49$162.38
El Centro, CACalifornia$260.56$162.45
Fresno, CACalifornia$260.49$162.38
Hanford, CACalifornia$260.49$162.38

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 West Virginia 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

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 20650 in West Virginia
ComponentRVULocality factorAdjusted
Physician work2.22× 1.0002.2200
Practice expense4.87× 0.8694.2320
Malpractice0.38× 1.4310.5438
Total RVUs6.9958
Conversion factor× 33.4009

Office rate, West Virginia$233.67

Office: (2.22 × 1 + 4.87 × 0.869 + 0.38 × 1.431) × $33.4009 = $233.67

Facility: (2.22 × 1 + 2.19 × 0.869 + 0.38 × 1.431) × $33.4009 = $155.88

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, West Virginia
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 West Virginia

20650 · Office / nonfacility

$233.67

Effective 2026-10-01

The base rate is $20.29 higher than on 2025-10-01, moving from $213.38 to $233.67 (9.5%).

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

    $213.38changed to$233.67

    • 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
    • Practice expense GPCI 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $217.42changed to$213.38

    • 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

    $213.87changed to$217.42

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $213.80changed to$213.87

    • 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
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $212.06changed to$213.80

    • 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
    • Practice expense GPCI 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $207.90changed to$212.06

    • 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

    $204.32changed to$207.90

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.48 changed to 3.84
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $204.45changed to$204.32

    • 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
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $203.45changed to$204.45

    • 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

    $198.46changed to$203.45

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.35 changed to 3.45
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $194.94changed to$198.46

    • 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
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $194.74changed to$194.94

    • 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

    $193.77changed to$194.74

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $190.24changed to$193.77

    • 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
    • Practice expense GPCI 0.832 changed to 0.836
    • Malpractice GPCI 1.256 changed to 1.282

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $190.83changed to$190.24

    • 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
    • Practice expense GPCI 0.828 changed to 0.832
    • Malpractice GPCI 1.229 changed to 1.256

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $190.83

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$233.67$155.88RVU26D
2026-07-01$233.67$155.88RVU26C
2026-04-01$233.67$155.88RVU26B
2026-01-01$233.67$155.88RVU26A
2025-10-01$213.38$159.28RVU25D
2025-07-01$213.38$159.28RVU25C
2025-04-01$213.38$159.28RVU25B
2025-01-01$213.38$159.28RVU25A
2024-10-01$217.42$161.47RVU24D
2024-07-01$217.42$161.47RVU24C
2024-04-01$217.42$161.47RVU24B
2024-03-09$217.42$161.47RVU24AR
2024-01-01$213.87$158.83RVU24A
2023-10-01$213.80$158.43RVU23D
2023-07-01$213.80$158.43RVU23C
2023-04-01$213.80$158.43RVU23B
2023-01-01$213.80$158.43RVU23A
2022-10-01$212.06$156.54RVU22D
2022-07-01$212.06$156.54RVU22C
2022-04-01$212.06$156.54RVU22B
2022-01-01$212.06$156.54RVU22A
2021-10-01$207.90$154.01RVU21D
2021-07-01$207.90$154.01RVU21C
2021-04-01$207.90$154.01RVU21B
2021-01-01$207.90$154.01RVU21A
2020-10-01$204.32$156.69RVU20D
2020-07-01$204.32$156.69RVU20C
2020-04-01$204.32$156.69RVU20B
2020-01-01$204.32$156.69RVU20A
2019-10-01$204.45$158.43RVU19D
2019-07-01$204.45$158.43RVU19C
2019-04-01$204.45$158.43RVU19B
2019-01-01$204.45$158.43RVU19A
2018-10-01$203.45$157.48RVU18D
2018-07-01$203.45$157.48RVU18C
2018-04-01$203.45$157.48RVU18B
2018-01-01$203.45$157.48RVU18AR1
2017-10-01$198.46$155.30RVU17D
2017-07-01$198.46$155.30RVU17C
2017-04-01$198.46$155.30RVU17B
2017-01-01$198.46$155.30RVU17A
2016-10-01$194.94$152.73RVU16D
2016-07-01$194.94$152.73RVU16C
2016-04-01$194.94$152.73RVU16B
2016-01-01$194.94$152.73RVU16A
2015-10-01$194.74$152.99RVU15D
2015-07-01$194.74$152.99RVU15C
2015-04-01$193.77$152.22RVU15B
2015-01-01$193.77$152.22RVU15A
2014-10-01$190.24$149.41RVU14D
2014-07-01$190.24$149.41RVU14C
2014-04-01$190.24$149.41RVU14B
2014-01-01$190.24$149.41RVU14A
2013-10-01$190.83$147.17RVU13D
2013-07-01$190.83$147.17RVU13C
2013-04-01$190.83$147.17RVU13B
2013-01-01$190.83$147.17RVU13AR

Price 20650 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

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 West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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