Billing code 20600: Joint aspiration/injectionMedicare rate & RVUs
Reports aspiration and/or injection of a small joint or bursa, such as a finger or toe joint, when the service is performed without ultrasound guidance.
Medicare pays $56.11 for 20600 nationally in the office and $31.40 in a hospital or facility. Local office rates run $50.30–$71.40.
Medicare rate · 20600
Joint aspiration/injection
Swap in your local Medicare rate.
- Work RVUs
- 0.64
- Total RVUs
- 1.68
- Global days
- 000
National rate · 2026
$56.11
Office setting, before claim adjustments.
See every locality for 20600 → · 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 20600 covers
This service covers needle aspiration, injection, or both in a small joint or bursa without ultrasound guidance. Common sites include the metacarpophalangeal or interphalangeal joints of the hand and the joints of the toes. Orthopedists, rheumatologists, primary care clinicians, and other clinicians who treat joint symptoms may perform it in an office or facility setting. Aspiration may be performed to evaluate or relieve a small-joint effusion; injection may be used to treat a joint condition or local inflammation.
Select the code by the treated structure’s size and whether ultrasound guidance is used: use 20600 for a small joint or bursa without ultrasound, 20604 for the ultrasound-guided small-joint service, and different codes for intermediate or major structures. Document the site, laterality, indication, and aspiration or injection performed. The 0-day global period includes same-day preoperative and postoperative care. For bilateral treatment, modifier 50 is paid at 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Medicare does not pay an assistant at surgery; 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 20600 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
$50.30 to $71.40
109 of 109 payment localities
20600 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.
$50.30
$67.69
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 | $67.69 | 1 |
| AL | $50.95 | 1 |
| AR | $50.30 | 1 |
| AZ | $54.73 | 1 |
| CA | $58.32–$71.40 | 29 |
| CO | $57.84 | 1 |
| CT | $59.57 | 1 |
| DC | $63.28 | 1 |
| DE | $55.57 | 1 |
| FL | $56.05–$61.51 | 3 |
| GA | $53.16–$57.23 | 2 |
| GU | $59.38 | 1 |
| HI | $59.38 | 1 |
| IA | $51.78 | 1 |
| ID | $52.14 | 1 |
| IL | $54.83–$59.88 | 4 |
| IN | $52.40 | 1 |
| KS | $51.71 | 1 |
| KY | $52.33 | 1 |
| LA | $52.31–$54.59 | 2 |
| MA | $57.61–$62.92 | 2 |
| MD | $56.49–$63.28 | 3 |
| ME | $52.54–$54.84 | 2 |
| MI | $53.67–$56.82 | 2 |
| MN | $55.16 | 1 |
| MO | $51.62–$54.58 | 3 |
| MS | $50.96 | 1 |
| MT | $56.11 | 1 |
| NC | $53.00 | 1 |
| ND | $54.53 | 1 |
| NE | $51.98 | 1 |
| NH | $57.09 | 1 |
| NJ | $60.18–$62.77 | 2 |
| NM | $53.99 | 1 |
| NV | $55.70 | 1 |
| NY | $53.72–$65.83 | 5 |
| OH | $53.35 | 1 |
| OK | $52.09 | 1 |
| OR | $55.19–$59.33 | 2 |
| PA | $53.34–$58.33 | 2 |
| PR | $56.43 | 1 |
| RI | $57.29 | 1 |
| SC | $53.28 | 1 |
| SD | $54.34 | 1 |
| TN | $51.96 | 1 |
| TX | $53.04–$57.71 | 8 |
| UT | $53.92 | 1 |
| VA | $54.78–$63.28 | 2 |
| VI | $56.43 | 1 |
| VT | $54.47 | 1 |
| WA | $57.45–$63.97 | 2 |
| WI | $52.92 | 1 |
| WV | $53.06 | 1 |
| WY | $55.42 | 1 |
How the 20600 rate is calculated
Each of 20600’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 · 20600
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.64Practice expense 0.96Malpractice 0.08
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 20600
The CMS indicators that decide how 20600 is paid alongside other services.
CMS payment indicators · 20600
Joint aspiration/injection
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
20600 without 50 · national office
$56.11
Joint aspiration/injection
20600-50 · Bilateral: 150%
$84.17
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
20600 compared with similar codes
Compare codes
20600 vs 20604 vs 20605 vs 20610 vs 20612: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 20604Joint aspiration or injection
- Both address small joints or bursae; 20604 is selected when ultrasound guidance is used, while 20600 is for treatment without ultrasound guidance.
- 20605Joint procedure
- 20605 is for an intermediate joint or bursa, such as the wrist or ankle; 20600 is for a small joint or bursa.
- 20610Joint injection
- 20610 applies to a major joint or bursa, such as the knee or shoulder; 20600 applies to a small joint or bursa.
- 20612Ganglion treatment
- 20612 is for aspiration or injection of a ganglion cyst, rather than aspiration or injection of a small joint or bursa.
20600 billing questions
When should 20600 be chosen instead of 20604?
Use 20600 for a small joint or bursa treated without ultrasound guidance. When ultrasound guidance is used for the small-joint service, use 20604.
How is a small joint distinguished from an intermediate joint?
20600 is for small joints, such as finger or toe joints; 20605 is for an intermediate joint or bursa. Select based on the treated structure, not the medication injected.
Can aspiration and injection at the same small joint be reported separately?
The service includes aspiration, injection, or both at the treated small joint or bursa. Do not report separate units merely because both actions were performed at that site.
How should bilateral small-joint treatment be reported?
When the procedure is performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.
What documentation supports reporting 20600?
Identify the small joint or bursa, side, clinical reason, whether fluid was aspirated or medication injected, and that ultrasound guidance was not used.
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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