CPT code 20697: Fixator adjustment, each strut2026 Medicare rate & RVUs
Reports adjustment or exchange of individual struts on a multiplane external fixation system, commonly during staged correction of a fracture or limb deformity.
Medicare pays $1,910.53 for 20697 nationally in the office. Local office rates run $1,640.80–$2,754.08.
Medicare rate · 20697
Fixator adjustment, each strut
- Work RVUs
- 0
- Total RVUs
- 57.20
- Global days
- 000
National rate · 2026
$1,910.53
Office setting, before claim adjustments.
See every locality for 20697 →Billed by an NP, PA or therapist? →
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 10 sections
What 20697 covers
This service covers changing or adjusting individual struts on a multiplane, or orthogonal, external fixation system. Orthopedic surgeons commonly perform it during staged treatment with a hexapod or similar frame, such as when correcting a fracture alignment or limb deformity. Unlike applying the frame, the work addresses its struts while the external fixation system remains in use.
Report the service for each strut adjusted or exchanged, and document the frame, the specific strut work, and the clinical reason for the change. CMS assigns this code a 0-day global period, so same-day preoperative and postoperative care is included. CMS classifies it as technical-component-only, with interpretation covered by a separate code. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is 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 20697 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$1640.80 to $2754.08
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $1,671.41 | Unavailable |
| Alaska | $2,034.20 | Unavailable |
| Arizona | $1,851.19 | Unavailable |
| Arkansas | $1,640.80 | Unavailable |
| Atlanta, GA | $1,941.29 | Unavailable |
| Austin, TX | $2,021.17 | Unavailable |
| Bakersfield, CA | $2,093.45 | Unavailable |
| Baltimore area, MD | $2,050.16 | Unavailable |
| Beaumont, TX | $1,738.60 | Unavailable |
| Brazoria, TX | $1,893.13 | Unavailable |
| Chicago, IL | $1,921.38 | Unavailable |
| Chico, CA | $2,093.38 | Unavailable |
| Colorado | $2,032.52 | Unavailable |
| Connecticut | $2,057.78 | Unavailable |
| Dallas, TX | $1,902.75 | Unavailable |
| Delaware | $1,887.52 | Unavailable |
| Detroit, MI | $1,844.39 | Unavailable |
| East St. Louis, IL | $1,758.79 | Unavailable |
| El Centro, CA | $2,093.39 | Unavailable |
| Fort Lauderdale, FL | $1,936.17 | Unavailable |
| Fort Worth, TX | $1,883.67 | Unavailable |
| Fresno, CA | $2,093.38 | Unavailable |
| Galveston, TX | $1,896.99 | Unavailable |
| Hanford, CA | $2,093.38 | Unavailable |
| Hawaii, Guam, HI | $2,171.72 | Unavailable |
| Houston, TX | $1,897.54 | Unavailable |
| Idaho | $1,757.24 | Unavailable |
| Indiana | $1,770.62 | Unavailable |
| Iowa | $1,747.62 | Unavailable |
| Kansas | $1,726.72 | Unavailable |
| Kentucky | $1,698.49 | Unavailable |
| King County, WA | $2,343.81 | Unavailable |
| Los Angeles, CA | $2,259.64 | Unavailable |
| Madera, CA | $2,093.38 | Unavailable |
| Manhattan, NY | $2,220.46 | Unavailable |
| Marin County, CA | $2,692.90 | Unavailable |
| Merced, CA | $2,093.38 | Unavailable |
| Metropolitan Boston, MA | $2,280.87 | Unavailable |
| Metropolitan Kansas City, MO | $1,794.03 | Unavailable |
| Metropolitan Philadelphia, PA | $1,989.02 | Unavailable |
| Metropolitan St. Louis, MO | $1,818.88 | Unavailable |
| Miami, FL | $1,990.35 | Unavailable |
| Minnesota | $1,965.20 | Unavailable |
| Mississippi | $1,644.85 | Unavailable |
| Modesto, CA | $2,093.38 | Unavailable |
| Montana | $1,910.53 | Unavailable |
| Napa, CA | $2,517.27 | Unavailable |
| Nebraska | $1,762.87 | Unavailable |
| Nevada | $1,912.27 | Unavailable |
| New Hampshire | $1,988.70 | Unavailable |
| New Mexico | $1,752.24 | Unavailable |
| New Orleans, LA | $1,798.01 | Unavailable |
| North Carolina | $1,782.23 | Unavailable |
| North Dakota | $1,909.94 | Unavailable |
| Northern New Jersey | $2,216.12 | Unavailable |
| NYC suburbs and Long Island, NY | $2,272.29 | Unavailable |
| Ohio | $1,744.41 | Unavailable |
| Oklahoma | $1,705.99 | Unavailable |
| Oxnard, CA | $2,257.69 | Unavailable |
| Portland, OR | $2,122.23 | Unavailable |
| Poughkeepsie and northern NYC suburbs, NY | $2,092.15 | Unavailable |
| Puerto Rico | $1,931.52 | Unavailable |
| Queens, NY | $2,258.51 | Unavailable |
| Redding, CA | $2,093.38 | Unavailable |
| Rest of California | $2,093.38 | Unavailable |
| Rest of Florida | $1,827.02 | Unavailable |
| Rest of Georgia | $1,704.49 | Unavailable |
| Rest of Illinois | $1,744.97 | Unavailable |
| Rest of Louisiana | $1,690.89 | Unavailable |
| Rest of Maine | $1,757.39 | Unavailable |
| Rest of Maryland | $1,933.36 | Unavailable |
| Rest of Massachusetts | $2,011.53 | Unavailable |
| Rest of Michigan | $1,744.53 | Unavailable |
| Rest of Missouri | $1,646.99 | Unavailable |
| Rest of New Jersey | $2,086.31 | Unavailable |
| Rest of New York | $1,814.76 | Unavailable |
| Rest of Oregon | $1,902.60 | Unavailable |
| Rest of Pennsylvania | $1,753.89 | Unavailable |
| Rest of Texas | $1,813.05 | Unavailable |
| Rest of Washington | $2,011.50 | Unavailable |
| Rhode Island | $1,973.44 | Unavailable |
| Riverside, CA | $2,093.70 | Unavailable |
| Sacramento, CA | $2,221.32 | Unavailable |
| Salinas, CA | $2,213.68 | Unavailable |
| San Benito County, CA | $2,754.08 | Unavailable |
| San Diego, CA | $2,284.34 | Unavailable |
| San Francisco, CA | $2,692.86 | Unavailable |
| San Luis Obispo, CA | $2,175.49 | Unavailable |
| Santa Clara County, CA | $2,753.94 | Unavailable |
| Santa Cruz, CA | $2,320.62 | Unavailable |
| Santa Maria, CA | $2,227.05 | Unavailable |
| Santa Rosa, CA | $2,345.44 | Unavailable |
| South Carolina | $1,765.26 | Unavailable |
| South Dakota | $1,909.87 | Unavailable |
| Southern Maine, ME | $1,892.98 | Unavailable |
| Stockton, CA | $2,093.38 | Unavailable |
| Suburban Chicago, IL | $1,962.86 | Unavailable |
| Tennessee | $1,736.30 | Unavailable |
| Utah | $1,795.86 | Unavailable |
| Vallejo, CA | $2,517.22 | Unavailable |
| Vermont | $1,890.94 | Unavailable |
| Virgin Islands, VI | $1,931.52 | Unavailable |
| Virginia | $1,877.77 | Unavailable |
| Visalia, CA | $2,093.38 | Unavailable |
| Washington, DC area | $2,250.54 | Unavailable |
| West Virginia | $1,660.81 | Unavailable |
| Wisconsin | $1,829.64 | Unavailable |
| Wyoming | $1,910.27 | Unavailable |
| Yuba City, CA | $2,093.38 | Unavailable |
20697 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.
$1,640.80
$2,423.73
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 | $2,034.20 | 1 |
| AL | $1,671.41 | 1 |
| AR | $1,640.80 | 1 |
| AZ | $1,851.19 | 1 |
| CA | $2,093.38–$2,754.08 | 29 |
| CO | $2,032.52 | 1 |
| CT | $2,057.78 | 1 |
| DC | $2,250.54 | 1 |
| DE | $1,887.52 | 1 |
| FL | $1,827.02–$1,990.35 | 3 |
| GA | $1,704.49–$1,941.29 | 2 |
| GU | $2,171.72 | 1 |
| HI | $2,171.72 | 1 |
| IA | $1,747.62 | 1 |
| ID | $1,757.24 | 1 |
| IL | $1,744.97–$1,962.86 | 4 |
| IN | $1,770.62 | 1 |
| KS | $1,726.72 | 1 |
| KY | $1,698.49 | 1 |
| LA | $1,690.89–$1,798.01 | 2 |
| MA | $2,011.53–$2,280.87 | 2 |
| MD | $1,933.36–$2,250.54 | 3 |
| ME | $1,757.39–$1,892.98 | 2 |
| MI | $1,744.53–$1,844.39 | 2 |
| MN | $1,965.20 | 1 |
| MO | $1,646.99–$1,818.88 | 3 |
| MS | $1,644.85 | 1 |
| MT | $1,910.53 | 1 |
| NC | $1,782.23 | 1 |
| ND | $1,909.94 | 1 |
| NE | $1,762.87 | 1 |
| NH | $1,988.70 | 1 |
| NJ | $2,086.31–$2,216.12 | 2 |
| NM | $1,752.24 | 1 |
| NV | $1,912.27 | 1 |
| NY | $1,814.76–$2,272.29 | 5 |
| OH | $1,744.41 | 1 |
| OK | $1,705.99 | 1 |
| OR | $1,902.60–$2,122.23 | 2 |
| PA | $1,753.89–$1,989.02 | 2 |
| PR | $1,931.52 | 1 |
| RI | $1,973.44 | 1 |
| SC | $1,765.26 | 1 |
| SD | $1,909.87 | 1 |
| TN | $1,736.30 | 1 |
| TX | $1,738.60–$2,021.17 | 8 |
| UT | $1,795.86 | 1 |
| VA | $1,877.77–$2,250.54 | 2 |
| VI | $1,931.52 | 1 |
| VT | $1,890.94 | 1 |
| WA | $2,011.50–$2,343.81 | 2 |
| WI | $1,829.64 | 1 |
| WV | $1,660.81 | 1 |
| WY | $1,910.27 | 1 |
How the 20697 rate is calculated
Each of 20697’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 · 20697
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense57.17
57.17 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
57.2000
Conversion factor
$33.4009
Medicare rate
$1,910.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20697
The CMS indicators that decide how 20697 is paid alongside other services.
CMS payment indicators · 20697
Fixator adjustment, each strut
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 3 | Technical component only. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
20697 without 80 · national office
$1,910.53
Fixator adjustment, each strut
20697-80 · Assistant: 16%
$305.68
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
20697 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 20696External fixationInitial computer-adjusted application
- Choose 20696 for initial application of the multiplane external fixation system. Choose 20697 for later adjustment or exchange of its struts.
- 20693Fixator adjustmentRequiring anesthesia
- 20693 describes adjustment or revision of an external fixation system requiring anesthesia. 20697 identifies strut work on a multiplane orthogonal system.
- 20694Fixator removalUnder anesthesia
- 20694 is for removal of an external fixation system under anesthesia; 20697 covers strut adjustment or exchange while the frame remains in use.
20697 billing questions
How does this differ from 20696?
20696 reports initial application of a multiplane external fixation system. Use 20697 for subsequent strut adjustment or exchange on the frame.
How does this differ from 20693?
20693 describes adjustment or revision of an external fixation system that requires anesthesia. Code 20697 is specific to strut adjustment or exchange on a multiplane orthogonal system.
How many units should be reported?
The code is reported for each strut adjusted or exchanged. Document which struts were changed and the work performed on each.
Is same-day postoperative care separately reported?
No. CMS assigns a 0-day global period, which includes same-day preoperative and postoperative care.
Can modifier 50 be used when struts on both sides are adjusted?
No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service according to the struts treated, not with modifier 50.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is 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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