CPT code 20665: Cranial device removal, tongs or halo2026 Medicare rate & RVUs
Removal of cranial traction tongs or a halo apparatus after treatment, reported when the device is removed as a separate service.
Medicare pays $117.91 for 20665 nationally in the office and $85.84 in a hospital or facility. Local office rates run $106.28–$151.94.
Medicare rate · 20665
Cranial device removal, tongs or halo
- Work RVUs
- 1.33
- Total RVUs
- 3.53
- Global days
- 010
National rate · 2026
$117.91
Office setting, before claim adjustments.
See every locality for 20665 →Billed by an NP, PA or therapist? →
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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On this page 10 sections
What 20665 covers
This service removes cranial traction tongs or a halo apparatus used to stabilize the head and cervical spine. It is typically performed by an orthopedic spine surgeon or neurosurgeon when the period of skeletal traction or halo immobilization is complete. Removal may take place in a facility or another setting equipped to manage the patient and device.
Report the removal service when tongs or a cranial halo are taken off separately, rather than as part of an application service that includes removal. The record should identify the device removed and document the removal performed. The code has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; 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.
Where 20665 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$106.28 to $151.94
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $107.58 | $79.53 |
| Alaska | $143.00 | $108.86 |
| Arizona | $115.21 | $84.14 |
| Arkansas | $106.28 | $78.74 |
| Atlanta, GA | $119.89 | $87.32 |
| Austin, TX | $121.62 | $87.70 |
| Bakersfield, CA | $124.01 | $88.87 |
| Baltimore area, MD | $124.58 | $90.18 |
| Beaumont, TX | $111.36 | $82.18 |
| Brazoria, TX | $116.82 | $85.05 |
| Chicago, IL | $123.32 | $91.10 |
| Chico, CA | $123.66 | $88.51 |
| Colorado | $122.10 | $87.98 |
| Connecticut | $124.94 | $90.41 |
| Dallas, TX | $117.50 | $85.57 |
| Delaware | $116.92 | $85.24 |
| Detroit, MI | $117.98 | $87.04 |
| East St. Louis, IL | $116.05 | $86.55 |
| El Centro, CA | $123.68 | $88.53 |
| Fort Lauderdale, FL | $121.78 | $89.30 |
| Fort Worth, TX | $116.85 | $85.24 |
| Fresno, CA | $123.66 | $88.51 |
| Galveston, TX | $117.14 | $85.30 |
| Hanford, CA | $123.66 | $88.51 |
| Hawaii, Guam, HI | $125.92 | $89.46 |
| Houston, TX | $119.15 | $87.31 |
| Idaho | $110.38 | $80.88 |
| Indiana | $110.92 | $81.20 |
| Iowa | $109.76 | $80.42 |
| Kansas | $109.38 | $80.39 |
| Kentucky | $109.84 | $81.34 |
| King County, WA | $135.30 | $95.96 |
| Los Angeles, CA | $131.27 | $93.33 |
| Madera, CA | $123.66 | $88.51 |
| Manhattan, NY | $134.21 | $96.95 |
| Marin County, CA | $148.76 | $103.55 |
| Merced, CA | $123.66 | $88.51 |
| Metropolitan Boston, MA | $132.87 | $94.58 |
| Metropolitan Kansas City, MO | $113.56 | $83.45 |
| Metropolitan Philadelphia, PA | $122.28 | $88.90 |
| Metropolitan St. Louis, MO | $114.56 | $84.04 |
| Miami, FL | $126.38 | $93.01 |
| Minnesota | $117.34 | $84.35 |
| Mississippi | $107.24 | $79.64 |
| Modesto, CA | $123.66 | $88.51 |
| Montana | $117.90 | $85.83 |
| Napa, CA | $141.10 | $98.83 |
| Nebraska | $110.24 | $80.65 |
| Nevada | $117.36 | $85.26 |
| New Hampshire | $120.31 | $86.93 |
| New Mexico | $112.85 | $83.45 |
| New Orleans, LA | $114.29 | $84.11 |
| North Carolina | $111.90 | $81.99 |
| North Dakota | $115.72 | $83.66 |
| Northern New Jersey | $132.12 | $94.93 |
| NYC suburbs and Long Island, NY | $137.09 | $98.97 |
| Ohio | $111.86 | $82.59 |
| Oklahoma | $109.62 | $80.98 |
| Oxnard, CA | $130.47 | $92.57 |
| Portland, OR | $125.42 | $89.80 |
| Poughkeepsie and northern NYC suburbs, NY | $127.31 | $92.20 |
| Puerto Rico | $118.62 | $86.20 |
| Queens, NY | $135.08 | $97.18 |
| Redding, CA | $123.66 | $88.51 |
| Rest of California | $123.66 | $88.51 |
| Rest of Florida | $116.68 | $86.03 |
| Rest of Georgia | $111.07 | $82.47 |
| Rest of Illinois | $113.90 | $84.63 |
| Rest of Louisiana | $109.72 | $81.35 |
| Rest of Maine | $110.93 | $81.43 |
| Rest of Maryland | $118.89 | $86.44 |
| Rest of Massachusetts | $121.57 | $87.81 |
| Rest of Michigan | $112.31 | $83.03 |
| Rest of Missouri | $108.18 | $80.54 |
| Rest of New Jersey | $126.46 | $91.45 |
| Rest of New York | $113.32 | $82.86 |
| Rest of Oregon | $116.53 | $84.60 |
| Rest of Pennsylvania | $111.98 | $82.54 |
| Rest of Texas | $113.99 | $83.56 |
| Rest of Washington | $121.30 | $87.54 |
| Rhode Island | $120.66 | $87.53 |
| Riverside, CA | $124.87 | $89.72 |
| Sacramento, CA | $129.18 | $91.89 |
| Salinas, CA | $128.68 | $91.51 |
| San Benito County, CA | $151.94 | $105.70 |
| San Diego, CA | $131.24 | $92.89 |
| San Francisco, CA | $148.63 | $103.42 |
| San Luis Obispo, CA | $126.66 | $90.14 |
| Santa Clara County, CA | $151.43 | $105.19 |
| Santa Cruz, CA | $132.14 | $93.18 |
| Santa Maria, CA | $129.03 | $91.64 |
| Santa Rosa, CA | $133.45 | $94.07 |
| South Carolina | $112.05 | $82.42 |
| South Dakota | $115.47 | $83.40 |
| Southern Maine, ME | $115.92 | $84.14 |
| Stockton, CA | $123.66 | $88.51 |
| Suburban Chicago, IL | $122.94 | $90.01 |
| Tennessee | $109.85 | $80.70 |
| Utah | $113.34 | $83.20 |
| Vallejo, CA | $140.92 | $98.65 |
| Vermont | $115.39 | $83.65 |
| Virgin Islands, VI | $118.62 | $86.20 |
| Virginia | $115.64 | $84.12 |
| Visalia, CA | $123.66 | $88.51 |
| Washington, DC area | $133.15 | $95.37 |
| West Virginia | $110.34 | $82.48 |
| Wisconsin | $112.43 | $81.71 |
| Wyoming | $116.95 | $84.89 |
| Yuba City, CA | $123.66 | $88.51 |
20665 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.
$106.28
$143.00
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 | $143.00 | 1 |
| AL | $107.58 | 1 |
| AR | $106.28 | 1 |
| AZ | $115.21 | 1 |
| CA | $123.66–$151.94 | 29 |
| CO | $122.10 | 1 |
| CT | $124.94 | 1 |
| DC | $133.15 | 1 |
| DE | $116.92 | 1 |
| FL | $116.68–$126.38 | 3 |
| GA | $111.07–$119.89 | 2 |
| GU | $125.92 | 1 |
| HI | $125.92 | 1 |
| IA | $109.76 | 1 |
| ID | $110.38 | 1 |
| IL | $113.90–$123.32 | 4 |
| IN | $110.92 | 1 |
| KS | $109.38 | 1 |
| KY | $109.84 | 1 |
| LA | $109.72–$114.29 | 2 |
| MA | $121.57–$132.87 | 2 |
| MD | $118.89–$133.15 | 3 |
| ME | $110.93–$115.92 | 2 |
| MI | $112.31–$117.98 | 2 |
| MN | $117.34 | 1 |
| MO | $108.18–$114.56 | 3 |
| MS | $107.24 | 1 |
| MT | $117.90 | 1 |
| NC | $111.90 | 1 |
| ND | $115.72 | 1 |
| NE | $110.24 | 1 |
| NH | $120.31 | 1 |
| NJ | $126.46–$132.12 | 2 |
| NM | $112.85 | 1 |
| NV | $117.36 | 1 |
| NY | $113.32–$137.09 | 5 |
| OH | $111.86 | 1 |
| OK | $109.62 | 1 |
| OR | $116.53–$125.42 | 2 |
| PA | $111.98–$122.28 | 2 |
| PR | $118.62 | 1 |
| RI | $120.66 | 1 |
| SC | $112.05 | 1 |
| SD | $115.47 | 1 |
| TN | $109.85 | 1 |
| TX | $111.36–$121.62 | 8 |
| UT | $113.34 | 1 |
| VA | $115.64–$133.15 | 2 |
| VI | $118.62 | 1 |
| VT | $115.39 | 1 |
| WA | $121.30–$135.30 | 2 |
| WI | $112.43 | 1 |
| WV | $110.34 | 1 |
| WY | $116.95 | 1 |
How the 20665 rate is calculated
Each of 20665’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 · 20665
RVUs × geographic indexes × conversion factor
Work1.33
1.33 RVUs× 1.000 GPCI
Practice expense2.09
2.09 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
3.5300
Conversion factor
$33.4009
Medicare rate
$117.91
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20665
20665 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20665
Cranial device removal, tongs or halo
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 20665
Cranial device removal, tongs or halo
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.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
20665 without 51 · national office
$117.91
Cranial device removal, tongs or halo
20665-51 · Second procedure: 50%
$58.96
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%).
20665 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 20660Cranial tractionTongs or calipers
- 20660 describes application of cranial tongs or another skeletal fixation device and includes removal. Report 20665 when the removal is a separate service.
- 20661Cranial haloFour-pin application
- 20661 describes cranial halo application, including removal. Use 20665 for removal performed separately from application.
- 20670Implant removalSuperficial hardware
- 20670 is for removal of a superficial orthopedic implant. 20665 is specific to cranial tongs or a halo.
- 20694Fixator removalUnder anesthesia
- 20694 describes removal of an external fixation system under anesthesia. 20665 is for cranial tongs or a halo.
20665 billing questions
When should 20665 be reported instead of a halo application code?
Use 20665 when cranial tongs or a halo are removed as a separate service. Application codes that include removal describe a different service when the device is applied.
Does 20665 include related follow-up visits?
Yes. The 10-day global period includes related postoperative visits during those 10 days.
Can modifier 50 be reported for removal on both sides?
No. Modifier 50 is inappropriate for this code.
How is 20665 affected when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
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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