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Billing code 20660: Cranial tractionMedicare rate & RVUs

Reports application and removal of cranial tongs, calipers, or similar fixation hardware to provide skeletal traction, commonly for cervical spine injuries.

CMS RVU26DEffective Oct 1, 2026109 payment localities354 Medicare services in 2024

Medicare pays $214.77 for 20660 nationally in a facility.

Medicare rate · 20660

Cranial traction

Swap in your local Medicare rate.

Work RVUs
3.9
Total RVUs
6.43
Global days
000

National rate · 2026

$214.77

Facility setting, before claim adjustments.

See every locality for 20660 → · 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
  1. Medicare rate
  2. What 20660 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 20660 covers

20660 covers placement of cranial tongs, calipers, or a comparable skull-anchored device to provide skeletal traction, with removal included. Orthopedic or spine surgeons commonly use it for cervical spine injuries requiring traction, often in an emergency department or hospital. The device applies controlled traction through cranial fixation rather than a halo frame.

Report the service when documentation supports application of cranial traction hardware, not placement of a cranial halo or a bone pin. Record the indication, device applied, and traction treatment; removal is included rather than separately reported. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. With other procedures in the same session, the highest-valued procedure is paid in full and other procedures receive the standard multiple-procedure reduction. Bilateral adjustment is not appropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery reporting 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 20660 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

20660 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$191.20
Alaska*Unavailable$263.76
ArizonaUnavailable$207.39
ArkansasUnavailable$188.38
AtlantaUnavailable$224.30
AustinUnavailable$212.69
BakersfieldUnavailable$204.86
Baltimore/Surr. CntysUnavailable$229.92
BeaumontUnavailable$207.96
BrazoriaUnavailable$206.17

20660 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.

View every state and territory as a table
20660 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 20660 rate is calculated

Each of 20660’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 · 20660

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 3.90Practice expense 1.27Malpractice 1.26

6.4300 adjusted RVUs×$33.4009 conversion factor=$214.77

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 20660

The CMS indicators that decide how 20660 is paid alongside other services.

CMS payment indicators · 20660

Cranial traction

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

20660 without 51 · national facility

$214.77

Cranial traction

20660-51 · Second procedure: 50%

$107.39

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%).

When to use modifier 51

20660 compared with similar codes

Compare codes

20660 vs 20661 vs 20664 vs 20665: national Medicare rates

Swap in your local Medicare rate.

  • 20660
    Cranial traction · 3.9 wRVU
    —
  • 20661
    Cranial halo · 5.13 wRVU
    —
  • 20664
    Cranial halo · 9.81 wRVU
    —
  • 20665
    Cranial device removal · 1.33 wRVU
    $117.91

How to choose

20661Cranial halo
Choose 20660 for cranial tongs, calipers, or comparable traction hardware. Choose 20661 for application of a cranial halo.
20664Cranial halo
20664 describes cranial halo application when the frame uses six or more pins; 20660 describes cranial traction tongs, calipers, or similar hardware.
20665Cranial device removal
20660 includes application and removal of cranial traction hardware. 20665 is for removal of a cranial device as a separate service.

Codes related to 20660

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

Codes related to 20660
CodeHow it relatesNational office range
Same family
20661Cranial haloCranial halo application rather than cranial tongs or calipers for skeletal traction.No office rate
20662Halo applicationHalo application at the pelvis, a different traction-device site.No office rate
20663Halo applicationHalo application at the femur, rather than cranial skeletal traction.No office rate
20664Cranial haloCranial halo application distinguished by a frame with six or more pins.No office rate

20660 billing questions

How does 20660 differ from cranial halo application?

20660 is for cranial tongs, calipers, or similar hardware used for skeletal traction. Use the halo application code when the service places a cranial halo frame.

Is removal separately reported after application?

Removal of the cranial traction device is included in 20660. A removal-only service is distinct from an application-and-removal service.

What documentation supports reporting 20660?

Document the clinical indication, the cranial traction device applied, and the traction treatment provided. The record should distinguish the device from a halo frame or bone pin.

Can modifier 50 be reported?

No. CMS identifies bilateral adjustment as inappropriate for this code.

How does Medicare handle other procedures performed in the same session?

The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction. Medicare also does not pay an assistant at surgery for 20660.

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 20660PPRRVU2026_Oct_nonQPP.csv, line 1,776 (RVU26D)

Open CMS sourceHow we calculate rates

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