Billing code 20650: Skeletal tractionMedicare rate & RVUs

Medicare pays $249.50 for 20650 nationally in the office and $159.99 in a hospital or facility. Local office rates run $220.41–$323.67.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 20650 covers

An orthopedic surgeon places a wire or pin through bone and connects it to a traction setup to apply controlled pulling force. A typical use is temporary skeletal traction during management of a fracture when traction through a pin is needed. The service may be performed in a hospital or another setting where the clinician can place and manage the traction apparatus. The code includes removal of the traction wire or pin when performed.

Report the service when documentation identifies the bone and insertion site, the clinical reason for skeletal traction, and the pin or wire placement and traction application. The 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; 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 20650 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

20650 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 20650 rate is calculated

Each of 20650’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.

Payment rules and modifiers for 20650

20650 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

20650 compared with similar codes

How to choose

20660Cranial traction

20650 uses a wire or pin inserted into bone to apply skeletal traction. 20660 is for application of cranial tongs, calipers, or another cranial fixation device.

20661Cranial halo

20661 describes application of a cranial halo. Choose 20650 for traction established by a wire or pin inserted into bone rather than a halo device.

20690External fixation

20690 describes application of a uniplanar external fixation system. It is not the code for a bone pin used to apply skeletal traction.

Codes related to 20650

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates