Billing code 20605: Joint procedureMedicare rate & RVUs
Report this service for aspiration and/or injection of an intermediate joint or bursa, such as the wrist, elbow, ankle, or acromioclavicular joint, without ultrasound guidance.
Medicare pays $57.12 for 20605 nationally in the office and $32.06 in a hospital or facility. Local office rates run $51.25–$72.62.
Medicare rate · 20605
Joint procedure
Swap in your local Medicare rate.
- Work RVUs
- 0.66
- Total RVUs
- 1.71
- Global days
- 000
National rate · 2026
$57.12
Office setting, before claim adjustments.
See every locality for 20605 → · 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 20605 covers
Orthopedists, rheumatologists, sports medicine clinicians, and other qualified practitioners use this service to withdraw fluid from or inject medication into an intermediate joint or bursa. Common targets include the wrist, elbow, ankle, acromioclavicular joint, and temporomandibular joint. It is performed in settings such as an office, clinic, or hospital outpatient department when the clinical need calls for treatment or fluid sampling at one of these sites without ultrasound guidance.
Select the code based on the treated site and whether aspiration, injection, or both are performed; document the specific joint or bursa, laterality, procedure, and clinical reason. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and applies the standard reduction to the others. For bilateral treatment reported with modifier 50, CMS pays 150%. Assistant-at-surgery services are not paid; 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 20605 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
$51.25 to $72.62
109 of 109 payment localities
20605 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.
$51.25
$69.04
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 | $69.04 | 1 |
| AL | $51.91 | 1 |
| AR | $51.25 | 1 |
| AZ | $55.73 | 1 |
| CA | $59.36–$72.62 | 29 |
| CO | $58.87 | 1 |
| CT | $60.61 | 1 |
| DC | $64.37 | 1 |
| DE | $56.57 | 1 |
| FL | $57.03–$62.53 | 3 |
| GA | $54.13–$58.24 | 2 |
| GU | $60.43 | 1 |
| HI | $60.43 | 1 |
| IA | $52.75 | 1 |
| ID | $53.12 | 1 |
| IL | $55.80–$60.89 | 4 |
| IN | $53.38 | 1 |
| KS | $52.68 | 1 |
| KY | $53.29 | 1 |
| LA | $53.28–$55.57 | 2 |
| MA | $58.64–$64.01 | 2 |
| MD | $57.51–$64.37 | 3 |
| ME | $53.51–$55.84 | 2 |
| MI | $54.64–$57.81 | 2 |
| MN | $56.17 | 1 |
| MO | $52.58–$55.57 | 3 |
| MS | $51.91 | 1 |
| MT | $57.11 | 1 |
| NC | $53.98 | 1 |
| ND | $55.53 | 1 |
| NE | $52.96 | 1 |
| NH | $58.11 | 1 |
| NJ | $61.24–$63.87 | 2 |
| NM | $54.96 | 1 |
| NV | $56.70 | 1 |
| NY | $54.70–$66.94 | 5 |
| OH | $54.32 | 1 |
| OK | $53.05 | 1 |
| OR | $56.19–$60.38 | 2 |
| PA | $54.31–$59.36 | 2 |
| PR | $57.43 | 1 |
| RI | $58.31 | 1 |
| SC | $54.25 | 1 |
| SD | $55.34 | 1 |
| TN | $52.93 | 1 |
| TX | $54.01–$58.73 | 8 |
| UT | $54.90 | 1 |
| VA | $55.78–$64.37 | 2 |
| VI | $57.43 | 1 |
| VT | $55.47 | 1 |
| WA | $58.48–$65.08 | 2 |
| WI | $53.91 | 1 |
| WV | $54.02 | 1 |
| WY | $56.42 | 1 |
How the 20605 rate is calculated
Each of 20605’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 · 20605
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.66Practice expense 0.97Malpractice 0.08
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 20605
The CMS indicators that decide how 20605 is paid alongside other services.
CMS payment indicators · 20605
Joint procedure
| 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
20605 without 50 · national office
$57.12
Joint procedure
20605-50 · Bilateral: 150%
$85.68
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).
20605 compared with similar codes
Compare codes
20605 vs 20600 vs 20606 vs 20610 vs 20611: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 20600Joint aspiration/injection
- Use 20600 for aspiration or injection of a small joint or bursa, rather than an intermediate site such as the wrist, elbow, or ankle.
- 20606Joint aspiration
- Both codes address intermediate joints or bursae; 20606 is for procedures performed with ultrasound guidance, while 20605 is without it.
- 20610Joint injection
- Use 20610 for a major joint or bursa, not an intermediate site. Both codes describe procedures performed without ultrasound guidance.
- 20611Joint aspiration/injection
- 20611 is for aspiration or injection at a major joint or bursa with ultrasound guidance; 20605 is for an intermediate site without ultrasound.
20605 billing questions
How does this differ from codes for small or major joints?
Choose the code level based on the joint or bursa treated. This code is for intermediate sites such as the wrist, elbow, ankle, acromioclavicular joint, or temporomandibular joint.
Can this code be reported when ultrasound guides the procedure?
No. For ultrasound-guided aspiration or injection of an intermediate joint or bursa, use 20606 instead.
What should the procedure note identify?
Document the specific joint or bursa, side, whether fluid was aspirated or medication injected, and the clinical reason for the procedure.
How is bilateral treatment reported under the CMS rule?
Report bilateral treatment with modifier 50; CMS pays 150% for the bilateral procedure.
Does the code include the injected medication?
The code describes the aspiration or injection procedure, not a particular drug. It does not by itself identify or report the medication administered.
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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