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CPT code 20665: Cranial device removal, tongs or halo2026 Medicare rate & RVUs in Indiana

Removal of cranial traction tongs or a halo apparatus after treatment, reported when the device is removed as a separate service.

CMS RVU26DEffective Oct 1, 2026One payment locality789 Medicare services in 2024

In Indiana, Medicare pays $110.92 for 20665 in the office and $81.20 when it’s performed in a hospital or facility.

$110.92Office (non-facility)
$81.20Hospital or facility
−5.9%vs the national office rate ($117.91)

Check a contract rate as a % of Medicare · 20665 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 20665 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Indiana
  2. What 20665 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 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.

How Indiana compares for 20665

Across 109 of 109 payment localities, the office rate for 20665 runs from $106.28 in Arkansas to $151.94 in San Benito County, CA. Indiana pays $110.92. The RVUs are the same everywhere; the geographic indexes change the dollars.

20665 in Indiana vs other payment areas
  1. Indiana · this page$110.92
  2. Los Angeles, CA · California$131.27+$20.35
  3. Washington, DC area · District of Columbia$133.15+$22.23
  4. Miami, FL · Florida$126.38+$15.46
  5. Chicago, IL · Illinois$123.32+$12.40
  6. Manhattan, NY · New York$134.21+$23.29
  7. Alaska · Alaska$143.00+$32.08

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

Every other payment area

20665 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$107.58$79.53
ArkansasArkansas$106.28$78.74
ArizonaArizona$115.21$84.14
Bakersfield, CACalifornia$124.01$88.87
Chico, CACalifornia$123.66$88.51
El Centro, CACalifornia$123.68$88.53
Fresno, CACalifornia$123.66$88.51
Hanford, CACalifornia$123.66$88.51

20665 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.

$106.28

$143.00

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

View every state and territory as a table
20665 office rate range by state
State / territoryOffice rate rangeLocalities
AK$143.001
AL$107.581
AR$106.281
AZ$115.211
CA$123.66–$151.9429
CO$122.101
CT$124.941
DC$133.151
DE$116.921
FL$116.68–$126.383
GA$111.07–$119.892
GU$125.921
HI$125.921
IA$109.761
ID$110.381
IL$113.90–$123.324
IN$110.921
KS$109.381
KY$109.841
LA$109.72–$114.292
MA$121.57–$132.872
MD$118.89–$133.153
ME$110.93–$115.922
MI$112.31–$117.982
MN$117.341
MO$108.18–$114.563
MS$107.241
MT$117.901
NC$111.901
ND$115.721
NE$110.241
NH$120.311
NJ$126.46–$132.122
NM$112.851
NV$117.361
NY$113.32–$137.095
OH$111.861
OK$109.621
OR$116.53–$125.422
PA$111.98–$122.282
PR$118.621
RI$120.661
SC$112.051
SD$115.471
TN$109.851
TX$111.36–$121.628
UT$113.341
VA$115.64–$133.152
VI$118.621
VT$115.391
WA$121.30–$135.302
WI$112.431
WV$110.341
WY$116.951

See 20665 in every payment locality

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

Office or facility?

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.

The exact Indiana inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,781

Code
20665
Physician work
1.33
Practice expense
2.09
Malpractice
0.11

GPCI2026.csv

52

Locality
Indiana
Physician work
1.000
Practice expense
0.927
Malpractice
0.486
Office calculation for 20665 in Indiana
ComponentRVULocality factorAdjusted
Physician work1.33× 1.0001.3300
Practice expense2.09× 0.9271.9374
Malpractice0.11× 0.4860.0535
Total RVUs3.3209
Conversion factor× 33.4009

Office rate, Indiana$110.92

Office: (1.33 × 1 + 2.09 × 0.927 + 0.11 × 0.486) × $33.4009 = $110.92

Facility: (1.33 × 1 + 1.13 × 0.927 + 0.11 × 0.486) × $33.4009 = $81.20

Open 20665 in the RVU calculator

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

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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
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 · 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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%).

When to use modifier 51

Codes related to 20665

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

Codes related to 20665
CodeHow it relatesOffice range, Indiana
Used instead
20660Cranial traction, tongs or calipersCranial tongs application code includes removal; 20665 describes removal separately.No office rate
20661Cranial halo, four-pin applicationCranial halo application code includes removal; 20665 is for separate removal.No office rate
20664Cranial halo, six or more pinsCranial halo application with six or more pins includes removal.No office rate
20670Implant removal, superficial hardwareFor removal of a superficial orthopedic implant, rather than cranial tongs or a halo.$343.67
20680Implant removal, deep implantFor removal of a deep orthopedic implant, rather than cranial tongs or a halo.$584.37
20694Fixator removal, under anesthesiaDescribes removal of an external fixation system under anesthesia, not cranial tongs or a halo.$426.74

How 20665 has changed in Indiana

20665 · Office / nonfacility

$110.92

Effective 2026-10-01

The base rate is $1.52 higher than on 2025-10-01, moving from $109.40 to $110.92 (1.4%).

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

    $109.40changed to$110.92

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.36 changed to 1.33
    • Practice expense RVU 2.13 changed to 2.09
    • Malpractice RVU 0.12 changed to 0.11
    • Practice expense GPCI 0.922 changed to 0.927
    • Malpractice GPCI 0.485 changed to 0.486

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $110.88changed to$109.40

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.08 changed to 2.13
    • Malpractice RVU 0.11 changed to 0.12

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $109.07changed to$110.88

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $111.14changed to$109.07

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.05 changed to 2.08
    • Practice expense GPCI 0.911 changed to 0.922
    • Malpractice GPCI 0.475 changed to 0.485

  5. January 1, 2023

    RVU23A

    $109.72changed to$111.14

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.96 changed to 2.05
    • Malpractice RVU 0.10 changed to 0.11
    • Practice expense GPCI 0.900 changed to 0.911
    • Malpractice GPCI 0.465 changed to 0.475

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $108.12changed to$109.72

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.88 changed to 1.96

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $107.60changed to$108.12

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.74 changed to 1.88
    • Malpractice RVU 0.09 changed to 0.10
    • Practice expense GPCI 0.910 changed to 0.900
    • Malpractice GPCI 0.422 changed to 0.465

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $105.69changed to$107.60

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.67 changed to 1.74
    • Malpractice RVU 0.10 changed to 0.09
    • Practice expense GPCI 0.919 changed to 0.910
    • Malpractice GPCI 0.379 changed to 0.422

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $103.59changed to$105.69

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.61 changed to 1.67

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $102.10changed to$103.59

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.56 changed to 1.61
    • Practice expense GPCI 0.920 changed to 0.919
    • Malpractice GPCI 0.498 changed to 0.379

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $101.69changed to$102.10

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.54 changed to 1.56
    • Practice expense GPCI 0.921 changed to 0.920
    • Malpractice GPCI 0.617 changed to 0.498

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $101.28changed to$101.69

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.51 changed to 1.54
    • Malpractice RVU 0.11 changed to 0.10

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $100.78changed to$101.28

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $100.69changed to$100.78

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.50 changed to 1.51
    • Practice expense GPCI 0.922 changed to 0.921
    • Malpractice GPCI 0.615 changed to 0.617

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $98.50changed to$100.69

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.59 changed to 1.50
    • Practice expense GPCI 0.923 changed to 0.922
    • Malpractice GPCI 0.613 changed to 0.615

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $98.50

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$110.92$81.20RVU26D
2026-07-01$110.92$81.20RVU26C
2026-04-01$110.92$81.20RVU26B
2026-01-01$110.92$81.20RVU26A
2025-10-01$109.40$91.50RVU25D
2025-07-01$109.40$91.50RVU25C
2025-04-01$109.40$91.50RVU25B
2025-01-01$109.40$91.50RVU25A
2024-10-01$110.88$92.16RVU24D
2024-07-01$110.88$92.16RVU24C
2024-04-01$110.88$92.16RVU24B
2024-03-09$110.88$92.16RVU24AR
2024-01-01$109.07$90.66RVU24A
2023-10-01$111.14$92.31RVU23D
2023-07-01$111.14$92.31RVU23C
2023-04-01$111.14$92.31RVU23B
2023-01-01$111.14$92.31RVU23A
2022-10-01$109.72$91.03RVU22D
2022-07-01$109.72$91.03RVU22C
2022-04-01$109.72$91.03RVU22B
2022-01-01$109.72$91.03RVU22A
2021-10-01$108.12$90.22RVU21D
2021-07-01$108.12$90.22RVU21C
2021-04-01$108.12$90.22RVU21B
2021-01-01$108.12$90.22RVU21A
2020-10-01$107.60$90.85RVU20D
2020-07-01$107.60$90.85RVU20C
2020-04-01$107.60$90.85RVU20B
2020-01-01$107.60$90.85RVU20A
2019-10-01$105.69$89.79RVU19D
2019-07-01$105.69$89.79RVU19C
2019-04-01$105.69$89.79RVU19B
2019-01-01$105.69$89.79RVU19A
2018-10-01$103.59$88.70RVU18D
2018-07-01$103.59$88.70RVU18C
2018-04-01$103.59$88.70RVU18B
2018-01-01$103.59$88.70RVU18AR1
2017-10-01$102.10$88.24RVU17D
2017-07-01$102.10$88.24RVU17C
2017-04-01$102.10$88.24RVU17B
2017-01-01$102.10$88.24RVU17A
2016-10-01$101.69$88.17RVU16D
2016-07-01$101.69$88.17RVU16C
2016-04-01$101.69$88.17RVU16B
2016-01-01$101.69$88.17RVU16A
2015-10-01$101.28$87.71RVU15D
2015-07-01$101.28$87.71RVU15C
2015-04-01$100.78$87.28RVU15B
2015-01-01$100.78$87.28RVU15A
2014-10-01$100.69$87.47RVU14D
2014-07-01$100.69$87.47RVU14C
2014-04-01$100.69$87.47RVU14B
2014-01-01$100.69$87.47RVU14A
2013-10-01$98.50$84.68RVU13D
2013-07-01$98.50$84.68RVU13C
2013-04-01$98.50$84.68RVU13B
2013-01-01$98.50$84.68RVU13AR

Price 20665 for an earlier date of service

Where the Indiana rate applies

Indiana is a Medicare payment area, not a city. Our Census mapping connects it to 974 cities and communities in Indiana. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Abington
  • Adams
  • Adams Lake
  • Advance
  • Akron
  • Alamo
  • Albany

Browse all communities in Indiana

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
RVUs for 20665PPRRVU2026_Oct_nonQPP.csv, line 1,781 (RVU26D)
Geographic factors for IndianaGPCI2026.csv, line 52 (RVU26D)

Open CMS sourceHow we calculate rates

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