Billing code 20500: Sinus tract injectionMedicare rate & RVUs
Report this service when a clinician injects a therapeutic agent into an existing sinus tract to treat the tract, rather than to map it diagnostically.
Medicare pays $128.59 for 20500 nationally in the office and $83.50 in a hospital or facility. Local office rates run $114.63–$167.03.
Medicare rate · 20500
Sinus tract injection
- Work RVUs
- 1.25
- Total RVUs
- 3.85
- Global days
- 010
National rate · 2026
$128.59
Office setting, before claim adjustments.
See every locality for 20500 →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.
On this page 10 sections
What 20500 covers
A clinician directs a therapeutic injection into an existing sinus tract. The defining feature is treatment through the tract itself, not an injection into nearby tissue or a study intended to show the tract’s course. The service may be performed in an office or facility by a physician or other qualified practitioner managing the tract. The record should identify the tract, the therapeutic purpose, the material delivered, and the technique used.
Choose this code based on therapeutic intent; use the diagnostic sinus-tract injection code when the injection is performed to evaluate or outline the tract. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is inappropriate for this descriptor and anatomy. CMS does not pay for an assistant at surgery, 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.
Where 20500 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
$114.63 to $167.03
109 of 109 payment localities
20500 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$114.63
$152.54
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 | $152.54 | 1 |
| AL | $116.19 | 1 |
| AR | $114.63 | 1 |
| AZ | $125.34 | 1 |
| CA | $134.83–$167.03 | 29 |
| CO | $133.23 | 1 |
| CT | $136.78 | 1 |
| DC | $145.98 | 1 |
| DE | $127.31 | 1 |
| FL | $127.51–$139.61 | 3 |
| GA | $120.72–$131.04 | 2 |
| GU | $137.70 | 1 |
| HI | $137.70 | 1 |
| IA | $118.62 | 1 |
| ID | $119.41 | 1 |
| IL | $124.29–$135.78 | 4 |
| IN | $120.04 | 1 |
| KS | $118.25 | 1 |
| KY | $119.08 | 1 |
| LA | $118.97–$124.45 | 2 |
| MA | $132.58–$145.63 | 2 |
| MD | $129.58–$145.98 | 3 |
| ME | $120.15–$126.01 | 2 |
| MI | $122.12–$129.17 | 2 |
| MN | $127.44 | 1 |
| MO | $117.17–$124.68 | 3 |
| MS | $115.91 | 1 |
| MT | $128.58 | 1 |
| NC | $121.30 | 1 |
| ND | $125.62 | 1 |
| NE | $119.18 | 1 |
| NH | $131.32 | 1 |
| NJ | $138.28–$144.66 | 2 |
| NM | $122.81 | 1 |
| NV | $127.84 | 1 |
| NY | $123.01–$151.03 | 5 |
| OH | $121.51 | 1 |
| OK | $118.72 | 1 |
| OR | $126.78–$137.06 | 2 |
| PA | $121.61–$133.67 | 2 |
| PR | $129.42 | 1 |
| RI | $131.55 | 1 |
| SC | $121.62 | 1 |
| SD | $125.27 | 1 |
| TN | $118.83 | 1 |
| TX | $120.87–$132.85 | 8 |
| UT | $123.17 | 1 |
| VA | $125.73–$145.98 | 2 |
| VI | $129.42 | 1 |
| VT | $125.30 | 1 |
| WA | $132.28–$148.34 | 2 |
| WI | $121.69 | 1 |
| WV | $120.03 | 1 |
| WY | $127.29 | 1 |
How the 20500 rate is calculated
Each of 20500’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 · 20500
RVUs × geographic indexes × conversion factor
Work1.25
1.25 RVUs× 1.000 GPCI
Practice expense2.45
2.45 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
3.8500
Conversion factor
$33.4009
Medicare rate
$128.59
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20500
20500 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20500
Sinus tract injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 20500
Sinus tract injection
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
20500 without 51 · national office
$128.59
Sinus tract injection
20500-51 · Second procedure: 50%
$64.30
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%).
20500 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 20501Sinus tract injection
- 20501 describes a diagnostic injection used to evaluate or outline a sinus tract; 20500 is for therapeutic treatment through the tract.
- 20550Tendon sheath injection
- 20550 targets a tendon sheath or ligament, not a sinus tract.
- 20551Tendon injection
- 20551 targets a tendon origin or insertion; use 20500 when the therapeutic injection is directed into a sinus tract.
20500 billing questions
How is this distinguished from code 20501?
Use 20500 when the injection treats the sinus tract. Use 20501 when the injection is diagnostic and intended to evaluate or outline it.
What should the procedure note include?
Document the sinus tract treated, the therapeutic intent, the material injected, and how it was delivered into the tract.
Can modifier 50 be reported for bilateral treatment?
No. The descriptor and anatomy make modifier 50 inappropriate.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and applies a 50% reduction to the other procedures.
Can an assistant, co-surgeon, or surgical team be billed?
CMS does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing 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
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