CPT code 20697: Fixator adjustment, each strut2026 Medicare rate & RVUs in Iowa

Reports adjustment or exchange of individual struts on a multiplane external fixation system, commonly during staged correction of a fracture or limb deformity.

CMS RVU26DEffective Oct 1, 2026One payment locality46 Medicare services in 2024

In Iowa, Medicare pays $1,747.62 for 20697 in the office.

$1,747.62Office (non-facility)
Not available in this settingHospital or facility
−8.5%vs the national office rate ($1,910.53)

Check a contract rate as a % of Medicare · 20697 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 20697 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Iowa
  2. What 20697 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 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.

How Iowa compares for 20697

Across 109 of 109 payment localities, the office rate for 20697 runs from $1,640.80 in Arkansas to $2,754.08 in San Benito County, CA. Iowa pays $1,747.62. The RVUs are the same everywhere; the geographic indexes change the dollars.

20697 in Iowa vs other payment areas
  1. Iowa · this page$1,747.62
  2. Los Angeles, CA · California$2,259.64+$512.02
  3. Washington, DC area · District of Columbia$2,250.54+$502.92
  4. Miami, FL · Florida$1,990.35+$242.73
  5. Chicago, IL · Illinois$1,921.38+$173.76
  6. Manhattan, NY · New York$2,220.46+$472.84
  7. Alaska · Alaska$2,034.20+$286.58

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

Every other payment area

20697 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$1,671.41—
ArkansasArkansas$1,640.80—
ArizonaArizona$1,851.19—
Bakersfield, CACalifornia$2,093.45—
Chico, CACalifornia$2,093.38—
El Centro, CACalifornia$2,093.39—
Fresno, CACalifornia$2,093.38—
Hanford, CACalifornia$2,093.38—

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
20697 office rate range by state
State / territoryOffice rate rangeLocalities
AK$2,034.201
AL$1,671.411
AR$1,640.801
AZ$1,851.191
CA$2,093.38–$2,754.0829
CO$2,032.521
CT$2,057.781
DC$2,250.541
DE$1,887.521
FL$1,827.02–$1,990.353
GA$1,704.49–$1,941.292
GU$2,171.721
HI$2,171.721
IA$1,747.621
ID$1,757.241
IL$1,744.97–$1,962.864
IN$1,770.621
KS$1,726.721
KY$1,698.491
LA$1,690.89–$1,798.012
MA$2,011.53–$2,280.872
MD$1,933.36–$2,250.543
ME$1,757.39–$1,892.982
MI$1,744.53–$1,844.392
MN$1,965.201
MO$1,646.99–$1,818.883
MS$1,644.851
MT$1,910.531
NC$1,782.231
ND$1,909.941
NE$1,762.871
NH$1,988.701
NJ$2,086.31–$2,216.122
NM$1,752.241
NV$1,912.271
NY$1,814.76–$2,272.295
OH$1,744.411
OK$1,705.991
OR$1,902.60–$2,122.232
PA$1,753.89–$1,989.022
PR$1,931.521
RI$1,973.441
SC$1,765.261
SD$1,909.871
TN$1,736.301
TX$1,738.60–$2,021.178
UT$1,795.861
VA$1,877.77–$2,250.542
VI$1,931.521
VT$1,890.941
WA$2,011.50–$2,343.812
WI$1,829.641
WV$1,660.811
WY$1,910.271

See 20697 in every payment locality

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

Office or facility?

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.

The exact Iowa inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,789

Code
20697
Physician work
0.00
Practice expense
57.17
Malpractice
0.03

GPCI2026.csv

53

Locality
Iowa
Physician work
1.000
Practice expense
0.915
Malpractice
0.397
Office calculation for 20697 in Iowa
ComponentRVULocality factorAdjusted
Physician work0.00× 1.0000.0000
Practice expense57.17× 0.91552.3106
Malpractice0.03× 0.3970.0119
Total RVUs52.3225
Conversion factor× 33.4009

Office rate, Iowa$1747.62

Office: (0 × 1 + 57.17 × 0.915 + 0.03 × 0.397) × $33.4009 = $1747.62

Open 20697 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical3Technical 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.

When to use modifier 80

How 20697 has changed in Iowa

20697 · Office / nonfacility

$1747.62

Effective 2026-10-01

The base rate is $249.00 higher than on 2025-10-01, moving from $1498.62 to $1747.62 (16.6%).

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

    $1498.62changed to$1747.62

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 50.73 changed to 57.17
    • Practice expense GPCI 0.913 changed to 0.915
    • Malpractice GPCI 0.457 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1613.33changed to$1498.62

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 53.07 changed to 50.73

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1587.00changed to$1613.33

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1692.33changed to$1587.00

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 54.86 changed to 53.07
    • Malpractice RVU 0.04 changed to 0.03
    • Practice expense GPCI 0.910 changed to 0.913
    • Malpractice GPCI 0.441 changed to 0.457
  5. January 1, 2023

    RVU23A

    $1772.74changed to$1692.33

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 56.46 changed to 54.86
    • Practice expense GPCI 0.907 changed to 0.910
    • Malpractice GPCI 0.425 changed to 0.441

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1936.82changed to$1772.74

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 61.18 changed to 56.46

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $1891.79changed to$1936.82

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 57.78 changed to 61.18
    • Malpractice RVU 0.03 changed to 0.04
    • Malpractice GPCI 0.424 changed to 0.425

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1925.42changed to$1891.79

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 58.89 changed to 57.78
    • Malpractice GPCI 0.423 changed to 0.424

    Held through RVU20B, RVU20C, RVU20D.

  9. July 1, 2019

    RVU19C

    $1925.27changed to$1925.42

    • Malpractice RVU 0.02 changed to 0.03

    Held through RVU19D.

  10. January 1, 2019

    RVU19A

    $1973.27changed to$1925.27

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 60.42 changed to 58.89
    • Malpractice RVU 0.03 changed to 0.02

    Held through RVU19B.

  11. January 1, 2018

    RVU18AR1

    $1933.08changed to$1973.27

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 59.70 changed to 60.42
    • Practice expense GPCI 0.902 changed to 0.907
    • Malpractice GPCI 0.458 changed to 0.423

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $1804.25changed to$1933.08

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 56.23 changed to 59.70
    • Malpractice RVU 0.02 changed to 0.03
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 0.493 changed to 0.458

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $1931.00changed to$1804.25

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 59.97 changed to 56.23
    • Malpractice RVU 0.01 changed to 0.02

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $1921.39changed to$1931.00

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $1659.22changed to$1921.39

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 51.92 changed to 59.97
    • Practice expense GPCI 0.892 changed to 0.896
    • Malpractice GPCI 0.475 changed to 0.493

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $1948.17changed to$1659.22

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 64.55 changed to 51.92
    • Practice expense GPCI 0.887 changed to 0.892
    • Malpractice GPCI 0.456 changed to 0.475

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $1948.17

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$1,747.62Not available in this settingRVU26D
2026-07-01$1,747.62Not available in this settingRVU26C
2026-04-01$1,747.62Not available in this settingRVU26B
2026-01-01$1,747.62Not available in this settingRVU26A
2025-10-01$1,498.62Not available in this settingRVU25D
2025-07-01$1,498.62Not available in this settingRVU25C
2025-04-01$1,498.62Not available in this settingRVU25B
2025-01-01$1,498.62Not available in this settingRVU25A
2024-10-01$1,613.33Not available in this settingRVU24D
2024-07-01$1,613.33Not available in this settingRVU24C
2024-04-01$1,613.33Not available in this settingRVU24B
2024-03-09$1,613.33Not available in this settingRVU24AR
2024-01-01$1,587.00Not available in this settingRVU24A
2023-10-01$1,692.33Not available in this settingRVU23D
2023-07-01$1,692.33Not available in this settingRVU23C
2023-04-01$1,692.33Not available in this settingRVU23B
2023-01-01$1,692.33Not available in this settingRVU23A
2022-10-01$1,772.74Not available in this settingRVU22D
2022-07-01$1,772.74Not available in this settingRVU22C
2022-04-01$1,772.74Not available in this settingRVU22B
2022-01-01$1,772.74Not available in this settingRVU22A
2021-10-01$1,936.82Not available in this settingRVU21D
2021-07-01$1,936.82Not available in this settingRVU21C
2021-04-01$1,936.82Not available in this settingRVU21B
2021-01-01$1,936.82Not available in this settingRVU21A
2020-10-01$1,891.79Not available in this settingRVU20D
2020-07-01$1,891.79Not available in this settingRVU20C
2020-04-01$1,891.79Not available in this settingRVU20B
2020-01-01$1,891.79Not available in this settingRVU20A
2019-10-01$1,925.42Not available in this settingRVU19D
2019-07-01$1,925.42Not available in this settingRVU19C
2019-04-01$1,925.27Not available in this settingRVU19B
2019-01-01$1,925.27Not available in this settingRVU19A
2018-10-01$1,973.27Not available in this settingRVU18D
2018-07-01$1,973.27Not available in this settingRVU18C
2018-04-01$1,973.27Not available in this settingRVU18B
2018-01-01$1,973.27Not available in this settingRVU18AR1
2017-10-01$1,933.08Not available in this settingRVU17D
2017-07-01$1,933.08Not available in this settingRVU17C
2017-04-01$1,933.08Not available in this settingRVU17B
2017-01-01$1,933.08Not available in this settingRVU17A
2016-10-01$1,804.25Not available in this settingRVU16D
2016-07-01$1,804.25Not available in this settingRVU16C
2016-04-01$1,804.25Not available in this settingRVU16B
2016-01-01$1,804.25Not available in this settingRVU16A
2015-10-01$1,931.00Not available in this settingRVU15D
2015-07-01$1,931.00Not available in this settingRVU15C
2015-04-01$1,921.39Not available in this settingRVU15B
2015-01-01$1,921.39Not available in this settingRVU15A
2014-10-01$1,659.22Not available in this settingRVU14D
2014-07-01$1,659.22Not available in this settingRVU14C
2014-04-01$1,659.22Not available in this settingRVU14B
2014-01-01$1,659.22Not available in this settingRVU14A
2013-10-01$1,948.17Not available in this settingRVU13D
2013-07-01$1,948.17Not available in this settingRVU13C
2013-04-01$1,948.17Not available in this settingRVU13B
2013-01-01$1,948.17Not available in this settingRVU13AR

Price 20697 for an earlier date of service

Where the Iowa rate applies

Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.

  • Ackley
  • Ackworth
  • Adair
  • Adel
  • Afton
  • Agency
  • Ainsworth
  • Akron

Browse all communities in Iowa

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
RVUs for 20697PPRRVU2026_Oct_nonQPP.csv, line 1,789 (RVU26D)
Geographic factors for IowaGPCI2026.csv, line 53 (RVU26D)

Open CMS sourceHow we calculate rates

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