CPT code 20665: Cranial device removal, tongs or halo2026 Medicare rate & RVUs in South Dakota
Removal of cranial traction tongs or a halo apparatus after treatment, reported when the device is removed as a separate service.
In South Dakota, Medicare pays $115.47 for 20665 in the office and $83.40 when it’s performed in a hospital or facility.
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.
On this page 11 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.
How South Dakota 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. South Dakota pays $115.47. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$115.47
- Los Angeles, CA · California$131.27+$15.80
- Washington, DC area · District of Columbia$133.15+$17.68
- Miami, FL · Florida$126.38+$10.91
- Chicago, IL · Illinois$123.32+$7.85
- Manhattan, NY · New York$134.21+$18.74
- Alaska · Alaska$143.00+$27.53
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $123.66 | $88.51 |
| Merced, CACalifornia | $123.66 | $88.51 |
| Modesto, CACalifornia | $123.66 | $88.51 |
| Napa, CACalifornia | $141.10 | $98.83 |
| Oxnard, CACalifornia | $130.47 | $92.57 |
| Redding, CACalifornia | $123.66 | $88.51 |
| Rest of CaliforniaCalifornia | $123.66 | $88.51 |
| Riverside, CACalifornia | $124.87 | $89.72 |
| Sacramento, CACalifornia | $129.18 | $91.89 |
| Salinas, CACalifornia | $128.68 | $91.51 |
| San Diego, CACalifornia | $131.24 | $92.89 |
| Marin County, CACalifornia | $148.76 | $103.55 |
| San Francisco, CACalifornia | $148.63 | $103.42 |
| San Benito County, CACalifornia | $151.94 | $105.70 |
| Santa Clara County, CACalifornia | $151.43 | $105.19 |
| San Luis Obispo, CACalifornia | $126.66 | $90.14 |
| Santa Cruz, CACalifornia | $132.14 | $93.18 |
| Santa Maria, CACalifornia | $129.03 | $91.64 |
| Santa Rosa, CACalifornia | $133.45 | $94.07 |
| Stockton, CACalifornia | $123.66 | $88.51 |
| Vallejo, CACalifornia | $140.92 | $98.65 |
| Visalia, CACalifornia | $123.66 | $88.51 |
| Yuba City, CACalifornia | $123.66 | $88.51 |
| ColoradoColorado | $122.10 | $87.98 |
| ConnecticutConnecticut | $124.94 | $90.41 |
| DelawareDelaware | $116.92 | $85.24 |
| Fort Lauderdale, FLFlorida | $121.78 | $89.30 |
| Rest of FloridaFlorida | $116.68 | $86.03 |
| Atlanta, GAGeorgia | $119.89 | $87.32 |
| Rest of GeorgiaGeorgia | $111.07 | $82.47 |
| Hawaii, Guam, HIHawaii | $125.92 | $89.46 |
| IowaIowa | $109.76 | $80.42 |
| IdahoIdaho | $110.38 | $80.88 |
| East St. Louis, ILIllinois | $116.05 | $86.55 |
| Rest of IllinoisIllinois | $113.90 | $84.63 |
| Suburban Chicago, ILIllinois | $122.94 | $90.01 |
| IndianaIndiana | $110.92 | $81.20 |
| KansasKansas | $109.38 | $80.39 |
| KentuckyKentucky | $109.84 | $81.34 |
| New Orleans, LALouisiana | $114.29 | $84.11 |
| Rest of LouisianaLouisiana | $109.72 | $81.35 |
| Metropolitan Boston, MAMassachusetts | $132.87 | $94.58 |
| Rest of MassachusettsMassachusetts | $121.57 | $87.81 |
| Baltimore area, MDMaryland | $124.58 | $90.18 |
| Rest of MarylandMaryland | $118.89 | $86.44 |
| Rest of MaineMaine | $110.93 | $81.43 |
| Southern Maine, MEMaine | $115.92 | $84.14 |
| Detroit, MIMichigan | $117.98 | $87.04 |
| Rest of MichiganMichigan | $112.31 | $83.03 |
| MinnesotaMinnesota | $117.34 | $84.35 |
| Metropolitan Kansas City, MOMissouri | $113.56 | $83.45 |
| Metropolitan St. Louis, MOMissouri | $114.56 | $84.04 |
| Rest of MissouriMissouri | $108.18 | $80.54 |
| MississippiMississippi | $107.24 | $79.64 |
| MontanaMontana | $117.90 | $85.83 |
| North CarolinaNorth Carolina | $111.90 | $81.99 |
| North DakotaNorth Dakota | $115.72 | $83.66 |
| NebraskaNebraska | $110.24 | $80.65 |
| New HampshireNew Hampshire | $120.31 | $86.93 |
| Northern New JerseyNew Jersey | $132.12 | $94.93 |
| Rest of New JerseyNew Jersey | $126.46 | $91.45 |
| New MexicoNew Mexico | $112.85 | $83.45 |
| NevadaNevada | $117.36 | $85.26 |
| NYC suburbs and Long Island, NYNew York | $137.09 | $98.97 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $127.31 | $92.20 |
| Queens, NYNew York | $135.08 | $97.18 |
| Rest of New YorkNew York | $113.32 | $82.86 |
| OhioOhio | $111.86 | $82.59 |
| OklahomaOklahoma | $109.62 | $80.98 |
| Portland, OROregon | $125.42 | $89.80 |
| Rest of OregonOregon | $116.53 | $84.60 |
| Metropolitan Philadelphia, PAPennsylvania | $122.28 | $88.90 |
| Rest of PennsylvaniaPennsylvania | $111.98 | $82.54 |
| Puerto RicoPuerto Rico | $118.62 | $86.20 |
| Rhode IslandRhode Island | $120.66 | $87.53 |
| South CarolinaSouth Carolina | $112.05 | $82.42 |
| TennesseeTennessee | $109.85 | $80.70 |
| Austin, TXTexas | $121.62 | $87.70 |
| Beaumont, TXTexas | $111.36 | $82.18 |
| Brazoria, TXTexas | $116.82 | $85.05 |
| Dallas, TXTexas | $117.50 | $85.57 |
| Fort Worth, TXTexas | $116.85 | $85.24 |
| Galveston, TXTexas | $117.14 | $85.30 |
| Houston, TXTexas | $119.15 | $87.31 |
| Rest of TexasTexas | $113.99 | $83.56 |
| UtahUtah | $113.34 | $83.20 |
| VirginiaVirginia | $115.64 | $84.12 |
| Virgin Islands, VIUnited States Virgin Islands | $118.62 | $86.20 |
| VermontVermont | $115.39 | $83.65 |
| Rest of WashingtonWashington | $121.30 | $87.54 |
| King County, WAWashington | $135.30 | $95.96 |
| WisconsinWisconsin | $112.43 | $81.71 |
| West VirginiaWest Virginia | $110.34 | $82.48 |
| WyomingWyoming | $116.95 | $84.89 |
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.
The exact South Dakota 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
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.33 | × 1.000 | 1.3300 |
| Practice expense | 2.09 | × 1.000 | 2.0900 |
| Malpractice | 0.11 | × 0.336 | 0.0370 |
| Total RVUs | 3.4570 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$115.47
Office: (1.33 × 1 + 2.09 × 1 + 0.11 × 0.336) × $33.4009 = $115.47
Facility: (1.33 × 1 + 1.13 × 1 + 0.11 × 0.336) × $33.4009 = $83.40
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%).
How 20665 has changed in South Dakota
20665 · Office / nonfacility
$115.47
Effective 2026-10-01
The base rate is $1.10 higher than on 2025-10-01, moving from $114.37 to $115.47 (1.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$114.37changed to$115.47
- 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
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$115.91changed to$114.37
- 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.
March 9, 2024
RVU24AR
$114.02changed to$115.91
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$116.91changed to$114.02
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.05 changed to 2.08
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$116.09changed to$116.91
- 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
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$114.26changed to$116.09
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.88 changed to 1.96
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$113.07changed to$114.26
- 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
- Malpractice GPCI 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$110.60changed to$113.07
- 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
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$108.32changed to$110.60
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.61 changed to 1.67
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$106.21changed to$108.32
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.56 changed to 1.61
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$105.26changed to$106.21
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.54 changed to 1.56
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$104.71changed to$105.26
- 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.
July 1, 2015
RVU15C
$104.19changed to$104.71
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$104.09changed to$104.19
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.50 changed to 1.51
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
$101.98changed to$104.09
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.59 changed to 1.50
- Malpractice GPCI 0.432 changed to 0.416
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $101.98
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $115.47 | $83.40 | RVU26D |
| 2026-07-01 | $115.47 | $83.40 | RVU26C |
| 2026-04-01 | $115.47 | $83.40 | RVU26B |
| 2026-01-01 | $115.47 | $83.40 | RVU26A |
| 2025-10-01 | $114.37 | $94.96 | RVU25D |
| 2025-07-01 | $114.37 | $94.96 | RVU25C |
| 2025-04-01 | $114.37 | $94.96 | RVU25B |
| 2025-01-01 | $114.37 | $94.96 | RVU25A |
| 2024-10-01 | $115.91 | $95.60 | RVU24D |
| 2024-07-01 | $115.91 | $95.60 | RVU24C |
| 2024-04-01 | $115.91 | $95.60 | RVU24B |
| 2024-03-09 | $115.91 | $95.60 | RVU24AR |
| 2024-01-01 | $114.02 | $94.04 | RVU24A |
| 2023-10-01 | $116.91 | $96.24 | RVU23D |
| 2023-07-01 | $116.91 | $96.24 | RVU23C |
| 2023-04-01 | $116.91 | $96.24 | RVU23B |
| 2023-01-01 | $116.91 | $96.24 | RVU23A |
| 2022-10-01 | $116.09 | $95.33 | RVU22D |
| 2022-07-01 | $116.09 | $95.33 | RVU22C |
| 2022-04-01 | $116.09 | $95.33 | RVU22B |
| 2022-01-01 | $116.09 | $95.33 | RVU22A |
| 2021-10-01 | $114.26 | $94.38 | RVU21D |
| 2021-07-01 | $114.26 | $94.38 | RVU21C |
| 2021-04-01 | $114.26 | $94.38 | RVU21B |
| 2021-01-01 | $114.26 | $94.38 | RVU21A |
| 2020-10-01 | $113.07 | $94.67 | RVU20D |
| 2020-07-01 | $113.07 | $94.67 | RVU20C |
| 2020-04-01 | $113.07 | $94.67 | RVU20B |
| 2020-01-01 | $113.07 | $94.67 | RVU20A |
| 2019-10-01 | $110.60 | $93.30 | RVU19D |
| 2019-07-01 | $110.60 | $93.30 | RVU19C |
| 2019-04-01 | $110.60 | $93.30 | RVU19B |
| 2019-01-01 | $110.60 | $93.30 | RVU19A |
| 2018-10-01 | $108.32 | $92.12 | RVU18D |
| 2018-07-01 | $108.32 | $92.12 | RVU18C |
| 2018-04-01 | $108.32 | $92.12 | RVU18B |
| 2018-01-01 | $108.32 | $92.12 | RVU18AR1 |
| 2017-10-01 | $106.21 | $91.14 | RVU17D |
| 2017-07-01 | $106.21 | $91.14 | RVU17C |
| 2017-04-01 | $106.21 | $91.14 | RVU17B |
| 2017-01-01 | $106.21 | $91.14 | RVU17A |
| 2016-10-01 | $105.26 | $90.58 | RVU16D |
| 2016-07-01 | $105.26 | $90.58 | RVU16C |
| 2016-04-01 | $105.26 | $90.58 | RVU16B |
| 2016-01-01 | $105.26 | $90.58 | RVU16A |
| 2015-10-01 | $104.71 | $89.98 | RVU15D |
| 2015-07-01 | $104.71 | $89.98 | RVU15C |
| 2015-04-01 | $104.19 | $89.53 | RVU15B |
| 2015-01-01 | $104.19 | $89.53 | RVU15A |
| 2014-10-01 | $104.09 | $89.76 | RVU14D |
| 2014-07-01 | $104.09 | $89.76 | RVU14C |
| 2014-04-01 | $104.09 | $89.76 | RVU14B |
| 2014-01-01 | $104.09 | $89.76 | RVU14A |
| 2013-10-01 | $101.98 | $87.01 | RVU13D |
| 2013-07-01 | $101.98 | $87.01 | RVU13C |
| 2013-04-01 | $101.98 | $87.01 | RVU13B |
| 2013-01-01 | $101.98 | $87.01 | RVU13AR |
Where the South Dakota rate applies
South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Agar
- Agency Village
- Akaska
- Albee
- Alcester
- Alexandria
- Allen
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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