CPT code 20680: Implant removal, deep implant2026 Medicare rate & RVUs in California
Reports operative removal of deeply buried orthopedic hardware, such as a plate, screw, or rod, when removal is a distinct surgical service.
Medicare pays $657.45–$814.76 for 20680 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 20680 covers
An orthopedic surgeon typically reports this service when removing hardware buried beneath soft tissue or bone, such as a plate and screws or an intramedullary rod. Removal may require an incision and dissection to expose the implant. It is performed in settings ranging from an operating room to a procedure room when the depth and complexity are suitable. The operative report should identify the implant, its anatomic site, and the work needed to reach and remove it.
Choose this code for deep hardware rather than a superficial implant removable with less extensive exposure. Report it for a distinct removal service, not merely to describe hardware taken out as an integral part of another operation. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 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 20680 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$657.45 to $814.76
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $660.43 | $400.15 |
| Chico, CA | $657.45 | $397.18 |
| El Centro, CA | $657.63 | $397.35 |
| Fresno, CA | $657.45 | $397.18 |
| Hanford, CA | $657.45 | $397.18 |
| Los Angeles, CA | $701.66 | $420.72 |
| Madera, CA | $657.45 | $397.18 |
| Marin County, CA | $796.24 | $461.40 |
| Merced, CA | $657.45 | $397.18 |
| Modesto, CA | $657.45 | $397.18 |
| Napa, CA | $754.74 | $441.74 |
| Oxnard, CA | $697.28 | $416.58 |
| Redding, CA | $657.45 | $397.18 |
| Rest of California | $657.45 | $397.18 |
| Riverside, CA | $668.87 | $408.59 |
| Sacramento, CA | $688.11 | $411.92 |
| Salinas, CA | $685.53 | $410.29 |
| San Benito County, CA | $814.76 | $472.31 |
| San Diego, CA | $700.44 | $416.41 |
| San Francisco, CA | $795.04 | $460.19 |
| San Luis Obispo, CA | $674.76 | $404.27 |
| Santa Clara County, CA | $809.84 | $467.39 |
| Santa Cruz, CA | $706.13 | $417.59 |
| Santa Maria, CA | $687.76 | $410.86 |
| Santa Rosa, CA | $713.10 | $421.48 |
| Stockton, CA | $657.45 | $397.18 |
| Vallejo, CA | $753.01 | $440.01 |
| Visalia, CA | $657.45 | $397.18 |
| Yuba City, CA | $657.45 | $397.18 |
How the 20680 rate is calculated
Each of 20680’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 · 20680
RVUs × geographic indexes × conversion factor
Work5.81
5.81 RVUs× 1.000 GPCI
Practice expense12.05
12.05 RVUs× 1.000 GPCI
Malpractice1.06
1.06 RVUs× 1.000 GPCI
Adjusted RVUs
18.9200
Conversion factor
$33.4009
Medicare rate
$631.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20680
20680 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20680
Implant removal, deep implant
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 20680
Implant removal, deep implant
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
20680 without 51 · national office
$631.95
Implant removal, deep implant
20680-51 · Second procedure: 50%
$315.98
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%).
20680 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 20670Implant removalSuperficial hardware
- 20670 is for superficial implants. Choose 20680 when hardware is deeply buried and requires operative exposure and dissection.
- 20694Fixator removalUnder anesthesia
- 20694 describes removal of an external fixation system under anesthesia; 20680 concerns a deeply implanted device rather than an external frame.
- 22852Spinal hardware removalPosterior segmental construct
- 22852 is the specific removal code for segmental posterior spinal instrumentation. Use it rather than 20680 when that spinal instrumentation is removed.
20680 billing questions
How does this differ from 20670?
Use 20680 for deeply buried hardware requiring operative exposure and dissection. Code 20670 describes removal of a superficial implant.
Can removal be reported with a reconstruction at the same site?
Removal may be separately reported when it is a distinct service rather than an integral step in the reconstruction. Document the separate removal work and check applicable code edits.
Is modifier 50 appropriate when hardware is removed on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
Does the code count each screw or plate component?
Do not treat every screw or component as a separate unit. Document the implant site and distinct removal work performed.
When can an assistant be reported?
Assistant-at-surgery payment is allowed 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
Fee sheets
Put 20680 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet