CPT code 20690: External fixation, unilateral, single-plane frame2026 Medicare rate & RVUs in Maryland
Report 20690 when an orthopedic surgeon applies a unilateral external fixation frame with pins or wires arranged in a single plane to stabilize bone.
CMS doesn’t publish an office rate for 20690 in Maryland.
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 9 sections
What 20690 covers
An orthopedic surgeon applies a unilateral external frame, anchoring it to bone with pins or wires arranged in one plane. The frame can stabilize a fracture or an osteotomy while the bone heals. This service is typically performed in an operating room or another surgical setting; the defining feature is the single-plane fixation configuration, not the number of pins or wires.
Choose this code when the operative record supports application of a single-plane frame, rather than a multiplanar construct. Document the treated side and bone, the indication, and the frame configuration. The 90-day global period includes the day-before preoperative visit and related postoperative care during that period. 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% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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 20690 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $578.79 |
| Rest of Maryland | Unavailable | $546.32 |
| Washington, DC area | Unavailable | $603.71 |
How the 20690 rate is calculated
Each of 20690’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 · 20690
RVUs × geographic indexes × conversion factor
Work8.56
8.56 RVUs× 1.000 GPCI
Practice expense6.05
6.05 RVUs× 1.000 GPCI
Malpractice1.73
1.73 RVUs× 1.000 GPCI
Adjusted RVUs
16.3400
Conversion factor
$33.4009
Medicare rate
$545.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20690
20690 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20690
External fixation, unilateral, single-plane frame
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 20690
External fixation, unilateral, single-plane frame
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
20690 without 51 · national facility
$545.77
External fixation, unilateral, single-plane frame
20690-51 · Second procedure: 50%
$272.89
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%).
20690 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 20692External fixationMultiplane, unilateral
- Choose 20690 for a single-plane external frame and 20692 for a frame with pins or wires in more than one plane.
- 20696External fixationInitial computer-adjusted application
- 20696 describes a multiplanar external fixation system with stereotactic computer-assisted adjustments; 20690 is for single-plane fixation without that feature.
- 20650Skeletal tractionBone pin insertion
- 20650 covers insertion or removal of a bone pin or wire. It does not describe application of the unilateral external fixation system reported with 20690.
20690 billing questions
How does 20690 differ from 20692?
20690 is for a unilateral external frame with pins or wires in one plane. Use 20692 when the fixation is arranged in more than one plane.
Is 20690 reported per pin or wire?
No. Select the code based on the external fixation system's configuration, not the number of pins or wires. Document the frame arrangement in the operative report.
Can modifier 50 be used when both sides are treated?
No. CMS identifies bilateral adjustment as inappropriate for 20690. The descriptor and anatomy do not support modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. The application and this related care are part of the surgical episode.
Can an assistant or co-surgeon be paid for 20690?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
How is 20690 paid when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
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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