CPT code 20660: Cranial traction, tongs or calipers2026 Medicare rate & RVUs in Missouri
Reports application and removal of cranial tongs, calipers, or similar fixation hardware to provide skeletal traction, commonly for cervical spine injuries.
CMS doesn’t publish an office rate for 20660 in Missouri.
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 20660 covers
20660 covers placement of cranial tongs, calipers, or a comparable skull-anchored device to provide skeletal traction, with removal included. Orthopedic or spine surgeons commonly use it for cervical spine injuries requiring traction, often in an emergency department or hospital. The device applies controlled traction through cranial fixation rather than a halo frame.
Report the service when documentation supports application of cranial traction hardware, not placement of a cranial halo or a bone pin. Record the indication, device applied, and traction treatment; removal is included rather than separately reported. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. With other procedures in the same session, the highest-valued procedure is paid in full and other procedures receive the standard multiple-procedure reduction. Bilateral adjustment is not appropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery reporting 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.
Where 20660 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $211.21 |
| Metropolitan St. Louis, MO | Unavailable | $212.82 |
| Rest of Missouri | Unavailable | $207.82 |
How the 20660 rate is calculated
Each of 20660’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 · 20660
RVUs × geographic indexes × conversion factor
Work3.90
3.90 RVUs× 1.000 GPCI
Practice expense1.27
1.27 RVUs× 1.000 GPCI
Malpractice1.26
1.26 RVUs× 1.000 GPCI
Adjusted RVUs
6.4300
Conversion factor
$33.4009
Medicare rate
$214.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20660
The CMS indicators that decide how 20660 is paid alongside other services.
CMS payment indicators · 20660
Cranial traction, tongs or calipers
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 51 · payment effect
With and without the modifier
20660 without 51 · national facility
$214.77
Cranial traction, tongs or calipers
20660-51 · Second procedure: 50%
$107.39
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%).
20660 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 20661Cranial haloFour-pin application
- Choose 20660 for cranial tongs, calipers, or comparable traction hardware. Choose 20661 for application of a cranial halo.
- 20664Cranial haloSix or more pins
- 20664 describes cranial halo application when the frame uses six or more pins; 20660 describes cranial traction tongs, calipers, or similar hardware.
- 20665Cranial device removalTongs or halo
- 20660 includes application and removal of cranial traction hardware. 20665 is for removal of a cranial device as a separate service.
20660 billing questions
How does 20660 differ from cranial halo application?
20660 is for cranial tongs, calipers, or similar hardware used for skeletal traction. Use the halo application code when the service places a cranial halo frame.
Is removal separately reported after application?
Removal of the cranial traction device is included in 20660. A removal-only service is distinct from an application-and-removal service.
What documentation supports reporting 20660?
Document the clinical indication, the cranial traction device applied, and the traction treatment provided. The record should distinguish the device from a halo frame or bone pin.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction. Medicare also does not pay an assistant at surgery for 20660.
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
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