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

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 North Carolina, Medicare pays $111.90 for 20665 in the office and $81.99 when it’s performed in a hospital or facility.

$111.90Office (non-facility)
$81.99Hospital or facility
−5.1%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 North Carolina
  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 North Carolina 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. North Carolina pays $111.90. The RVUs are the same everywhere; the geographic indexes change the dollars.

20665 in North Carolina vs other payment areas
  1. North Carolina · this page$111.90
  2. Los Angeles, CA · California$131.27+$19.37
  3. Washington, DC area · District of Columbia$133.15+$21.25
  4. Miami, FL · Florida$126.38+$14.48
  5. Chicago, IL · Illinois$123.32+$11.42
  6. Manhattan, NY · New York$134.21+$22.31
  7. Alaska · Alaska$143.00+$31.10

Other areas in North Carolina 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 North Carolina 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

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 20665 in North Carolina
ComponentRVULocality factorAdjusted
Physician work1.33× 1.0001.3300
Practice expense2.09× 0.9331.9500
Malpractice0.11× 0.6390.0703
Total RVUs3.3503
Conversion factor× 33.4009

Office rate, North Carolina$111.90

Office: (1.33 × 1 + 2.09 × 0.933 + 0.11 × 0.639) × $33.4009 = $111.90

Facility: (1.33 × 1 + 1.13 × 0.933 + 0.11 × 0.639) × $33.4009 = $81.99

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, North Carolina
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.$346.86
20680Implant removal, deep implantFor removal of a deep orthopedic implant, rather than cranial tongs or a halo.$592.20
20694Fixator removal, under anesthesiaDescribes removal of an external fixation system under anesthesia, not cranial tongs or a halo.$432.56

How 20665 has changed in North Carolina

20665 · Office / nonfacility

$111.90

Effective 2026-10-01

The base rate is $1.53 higher than on 2025-10-01, moving from $110.37 to $111.90 (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

    $110.37changed to$111.90

    • 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 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $111.82changed to$110.37

    • 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

    $110.00changed to$111.82

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $113.25changed to$110.00

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.05 changed to 2.08
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $112.84changed to$113.25

    • 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 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $111.19changed to$112.84

    • 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

    $109.94changed to$111.19

    • 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 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $107.55changed to$109.94

    • 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 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $105.42changed to$107.55

    • 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

    $103.56changed to$105.42

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.56 changed to 1.61
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $102.72changed to$103.56

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.54 changed to 1.56
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $102.37changed to$102.72

    • 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

    $101.86changed to$102.37

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $101.52changed to$101.86

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.50 changed to 1.51
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $99.02changed to$101.52

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.59 changed to 1.50
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $99.02

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$111.90$81.99RVU26D
2026-07-01$111.90$81.99RVU26C
2026-04-01$111.90$81.99RVU26B
2026-01-01$111.90$81.99RVU26A
2025-10-01$110.37$92.40RVU25D
2025-07-01$110.37$92.40RVU25C
2025-04-01$110.37$92.40RVU25B
2025-01-01$110.37$92.40RVU25A
2024-10-01$111.82$93.02RVU24D
2024-07-01$111.82$93.02RVU24C
2024-04-01$111.82$93.02RVU24B
2024-03-09$111.82$93.02RVU24AR
2024-01-01$110.00$91.50RVU24A
2023-10-01$113.25$94.09RVU23D
2023-07-01$113.25$94.09RVU23C
2023-04-01$113.25$94.09RVU23B
2023-01-01$113.25$94.09RVU23A
2022-10-01$112.84$93.57RVU22D
2022-07-01$112.84$93.57RVU22C
2022-04-01$112.84$93.57RVU22B
2022-01-01$112.84$93.57RVU22A
2021-10-01$111.19$92.73RVU21D
2021-07-01$111.19$92.73RVU21C
2021-04-01$111.19$92.73RVU21B
2021-01-01$111.19$92.73RVU21A
2020-10-01$109.94$92.82RVU20D
2020-07-01$109.94$92.82RVU20C
2020-04-01$109.94$92.82RVU20B
2020-01-01$109.94$92.82RVU20A
2019-10-01$107.55$91.45RVU19D
2019-07-01$107.55$91.45RVU19C
2019-04-01$107.55$91.45RVU19B
2019-01-01$107.55$91.45RVU19A
2018-10-01$105.42$90.34RVU18D
2018-07-01$105.42$90.34RVU18C
2018-04-01$105.42$90.34RVU18B
2018-01-01$105.42$90.34RVU18AR1
2017-10-01$103.56$89.53RVU17D
2017-07-01$103.56$89.53RVU17C
2017-04-01$103.56$89.53RVU17B
2017-01-01$103.56$89.53RVU17A
2016-10-01$102.72$89.07RVU16D
2016-07-01$102.72$89.07RVU16C
2016-04-01$102.72$89.07RVU16B
2016-01-01$102.72$89.07RVU16A
2015-10-01$102.37$88.67RVU15D
2015-07-01$102.37$88.67RVU15C
2015-04-01$101.86$88.22RVU15B
2015-01-01$101.86$88.22RVU15A
2014-10-01$101.52$88.21RVU14D
2014-07-01$101.52$88.21RVU14C
2014-04-01$101.52$88.21RVU14B
2014-01-01$101.52$88.21RVU14A
2013-10-01$99.02$85.14RVU13D
2013-07-01$99.02$85.14RVU13C
2013-04-01$99.02$85.14RVU13B
2013-01-01$99.02$85.14RVU13AR

Price 20665 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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 North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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