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CPT code 20694: Fixator removal, under anesthesia2026 Medicare rate & RVUs in Puerto Rico

Removal of an external fixation frame under anesthesia, typically after fracture healing or completion of staged bone correction.

CMS RVU26DEffective Oct 1, 2026One payment locality5.2K Medicare services in 2024

In Puerto Rico, Medicare pays $464.80 for 20694 in the office and $329.72 when it’s performed in a hospital or facility.

$464.80Office (non-facility)
$329.72Hospital or facility
+0.6%vs the national office rate ($461.93)

Check a contract rate as a % of Medicare · 20694 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 20694 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 20694 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 20694 covers

An orthopedic surgeon removes an external fixation system while the patient is under anesthesia. The device may stabilize a fracture, support an osteotomy, or maintain alignment during limb-lengthening or deformity correction. This service is commonly performed in an operating room or another setting where anesthesia is provided. It concerns removal of the external frame and its fixation elements, rather than removal of buried internal plates, screws, or other implants.

Report this code when the external fixation system is removed under anesthesia; documentation should identify the device, the reason for removal, and the work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted, and co-surgeon and team-surgery billing 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 Puerto Rico compares for 20694

Across 109 of 109 payment localities, the office rate for 20694 runs from $407.36 in Arkansas to $595.96 in San Benito County, CA. Puerto Rico pays $464.80. The RVUs are the same everywhere; the geographic indexes change the dollars.

20694 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$464.80
  2. Los Angeles, CA · California$513.00+$48.20
  3. Washington, DC area · District of Columbia$525.17+$60.37
  4. Miami, FL · Florida$514.43+$49.63
  5. Chicago, IL · Illinois$498.56+$33.76
  6. Manhattan, NY · New York$534.31+$69.51
  7. Alaska · Alaska$538.98+$74.18

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

Every other payment area

20694 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$413.45$296.55
ArkansasArkansas$407.36$292.60
ArizonaArizona$448.95$319.49
Bakersfield, CACalifornia$482.71$336.28
Chico, CACalifornia$480.50$334.07
El Centro, CACalifornia$480.63$334.20
Fresno, CACalifornia$480.50$334.07
Hanford, CACalifornia$480.50$334.07

20694 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.

$407.36

$538.98

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

View every state and territory as a table
20694 office rate range by state
State / territoryOffice rate rangeLocalities
AK$538.981
AL$413.451
AR$407.361
AZ$448.951
CA$480.50–$595.9629
CO$476.791
CT$493.071
DC$525.171
DE$456.411
FL$462.17–$514.433
GA$435.00–$472.402
GU$491.411
HI$491.411
IA$420.841
ID$424.331
IL$451.02–$498.564
IN$426.741
KS$420.411
KY$426.811
LA$426.76–$448.042
MA$474.51–$522.222
MD$464.72–$525.173
ME$428.26–$449.532
MI$439.56–$469.672
MN$451.951
MO$420.36–$447.773
MS$413.871
MT$461.881
NC$432.561
ND$446.261
NE$422.711
NH$470.781
NJ$497.32–$519.912
NM$442.651
NV$457.821
NY$439.28–$549.465
OH$436.371
OK$424.351
OR$452.91–$490.292
PA$436.19–$481.682
PR$464.801
RI$471.511
SC$435.461
SD$444.411
TN$422.761
TX$433.40–$476.398
UT$441.471
VA$449.14–$525.172
VI$464.801
VT$445.941
WA$473.14–$531.322
WI$431.231
WV$434.501
WY$455.071

See 20694 in every payment locality

How the 20694 rate is calculated

Each of 20694’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 · 20694

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.17

4.17 RVUs× 1.000 GPCI

Practice expense8.87

8.87 RVUs× 1.000 GPCI

Malpractice0.79

0.79 RVUs× 1.000 GPCI

Adjusted RVUs

13.8300

Conversion factor

$33.4009

Medicare rate

$461.93

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,787

Code
20694
Physician work
4.17
Practice expense
8.87
Malpractice
0.79

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 20694 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work4.17× 1.0004.1700
Practice expense8.87× 1.0118.9676
Malpractice0.79× 0.9850.7782
Total RVUs13.9157
Conversion factor× 33.4009

Office rate, Puerto Rico$464.80

Office: (4.17 × 1 + 8.87 × 1.011 + 0.79 × 0.985) × $33.4009 = $464.80

Facility: (4.17 × 1 + 4.87 × 1.011 + 0.79 × 0.985) × $33.4009 = $329.72

Open 20694 in the RVU calculator

Payment rules and modifiers for 20694

20694 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 20694

Fixator removal, under anesthesia

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 20694

Fixator removal, under anesthesia

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

20694 without 51 · national office

$461.93

Fixator removal, under anesthesia

20694-51 · Second procedure: 50%

$230.97

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 20694

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

Codes related to 20694
CodeHow it relatesOffice range, Puerto Rico
Used instead
20693Fixator adjustment, requiring anesthesiaReports adjustment or revision under anesthesia when the external fixation system is retained.No office rate
20665Cranial device removal, tongs or haloRemoval code for cranial tongs or a halo rather than an external fixation system.$118.62
20670Implant removal, superficial hardwareRemoval of a superficial internal implant, not an external fixation frame.$373.61
20680Implant removal, deep implantRemoval of a deep internal implant, such as buried fixation hardware.$635.84

How 20694 has changed in Puerto Rico

20694 · Office / nonfacility

$464.80

Effective 2026-10-01

The base rate is $37.75 higher than on 2025-10-01, moving from $427.05 to $464.80 (8.8%).

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

    $427.05changed to$464.80

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.28 changed to 4.17
    • Practice expense RVU 8.09 changed to 8.87
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $437.47changed to$427.05

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.04 changed to 8.09
    • Malpractice RVU 0.78 changed to 0.79

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $430.33changed to$437.47

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $441.59changed to$430.33

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.93 changed to 8.04
    • Malpractice RVU 0.77 changed to 0.78
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $439.86changed to$441.59

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $444.38changed to$439.86

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.74 changed to 7.93
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $446.68changed to$444.38

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.72 changed to 7.74
    • Malpractice RVU 0.75 changed to 0.77

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $443.84changed to$446.68

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.20 changed to 7.72
    • Malpractice RVU 0.77 changed to 0.75
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $441.56changed to$443.84

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.15 changed to 7.20
    • Malpractice RVU 0.78 changed to 0.77
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $440.35changed to$441.56

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.13 changed to 7.15

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $388.54changed to$440.35

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.07 changed to 7.13
    • Malpractice RVU 0.77 changed to 0.78
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $340.24changed to$388.54

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.08 changed to 7.07
    • Malpractice RVU 0.79 changed to 0.77
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $341.32changed to$340.24

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.07 changed to 7.08
    • Malpractice RVU 0.80 changed to 0.79

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $339.62changed to$341.32

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $334.18changed to$339.62

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.01 changed to 7.07
    • Malpractice RVU 0.73 changed to 0.80
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $330.14changed to$334.18

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.72 changed to 7.01
    • Malpractice RVU 0.76 changed to 0.73
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $330.14

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$464.80$329.72RVU26D
2026-07-01$464.80$329.72RVU26C
2026-04-01$464.80$329.72RVU26B
2026-01-01$464.80$329.72RVU26A
2025-10-01$427.05$342.04RVU25D
2025-07-01$427.05$342.04RVU25C
2025-04-01$427.05$342.04RVU25B
2025-01-01$427.05$342.04RVU25A
2024-10-01$437.47$347.64RVU24D
2024-07-01$437.47$347.64RVU24C
2024-04-01$437.47$347.64RVU24B
2024-03-09$437.47$347.64RVU24AR
2024-01-01$430.33$341.96RVU24A
2023-10-01$441.59$349.02RVU23D
2023-07-01$439.86$348.02RVU23C
2023-04-01$439.86$348.02RVU23B
2023-01-01$439.86$348.02RVU23A
2022-10-01$444.38$349.50RVU22D
2022-07-01$444.38$349.50RVU22C
2022-04-01$444.38$349.50RVU22B
2022-01-01$444.38$349.50RVU22A
2021-10-01$446.68$349.25RVU21D
2021-07-01$446.68$349.25RVU21C
2021-04-01$446.68$349.25RVU21B
2021-01-01$446.68$349.25RVU21A
2020-10-01$443.84$351.81RVU20D
2020-07-01$443.84$351.81RVU20C
2020-04-01$443.84$351.81RVU20B
2020-01-01$443.84$351.81RVU20A
2019-10-01$441.56$351.56RVU19D
2019-07-01$441.56$351.56RVU19C
2019-04-01$441.56$351.56RVU19B
2019-01-01$441.56$351.56RVU19A
2018-10-01$440.35$351.53RVU18D
2018-07-01$440.35$351.53RVU18C
2018-04-01$440.35$351.53RVU18B
2018-01-01$440.35$351.53RVU18AR1
2017-10-01$388.54$314.20RVU17D
2017-07-01$388.54$314.20RVU17C
2017-04-01$388.54$314.20RVU17B
2017-01-01$388.54$314.20RVU17A
2016-10-01$340.24$278.91RVU16D
2016-07-01$340.24$278.91RVU16C
2016-04-01$340.24$278.91RVU16B
2016-01-01$340.24$278.91RVU16A
2015-10-01$341.32$279.26RVU15D
2015-07-01$341.32$279.26RVU15C
2015-04-01$339.62$277.87RVU15B
2015-01-01$339.62$277.87RVU15A
2014-10-01$334.18$274.94RVU14D
2014-07-01$334.18$274.94RVU14C
2014-04-01$334.18$274.94RVU14B
2014-01-01$334.18$274.94RVU14A
2013-10-01$330.14$268.32RVU13D
2013-07-01$330.14$268.32RVU13C
2013-04-01$330.14$268.32RVU13B
2013-01-01$330.14$268.32RVU13AR

Price 20694 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

20694 billing questions

When should this code be chosen instead of 20693?

Use 20694 when the external fixation system is removed under anesthesia. Code 20693 describes adjustment or revision of the system under anesthesia when it remains in place.

Is this the code for removing buried plates or screws?

No. It covers removal of an external fixation system. Codes 20670 and 20680 concern removal of superficial and deep internal implants, respectively.

Can modifier 50 be used when fixators are removed on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service according to the documented procedure rather than appending modifier 50.

What documentation supports reporting 20694?

Document the external fixation device, the clinical reason for removal, that removal was performed under anesthesia, and the operative work completed.

How does the 90-day global period affect follow-up billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

Can an assistant surgeon or co-surgeon be reported?

CMS lists a statutory restriction on assistant-at-surgery payment for this code. 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 20694PPRRVU2026_Oct_nonQPP.csv, line 1,787 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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