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CPT code 20690: External fixation2026 Medicare rate & RVUs

Report 20690 when an orthopedic surgeon applies a unilateral external fixation frame with pins or wires arranged in a single plane to stabilize bone.

CMS RVU26DEffective Oct 1, 2026109 payment localities3.2K Medicare services in 2024

Medicare pays $545.77 for 20690 nationally in a facility.

Medicare rate · 20690

External fixation

Work RVUs
8.56
Total RVUs
16.34
Global days
090

National rate · 2026

$545.77

Facility setting, before claim adjustments.

See every locality for 20690 →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 20690 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 20690 covers

An orthopedic surgeon applies a unilateral external frame, anchoring it to bone with pins or wires arranged in one plane. The frame can stabilize a fracture or an osteotomy while the bone heals. This service is typically performed in an operating room or another surgical setting; the defining feature is the single-plane fixation configuration, not the number of pins or wires.

Choose this code when the operative record supports application of a single-plane frame, rather than a multiplanar construct. Document the treated side and bone, the indication, and the frame configuration. The 90-day global period includes the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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 20690 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

20690 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$495.43
Alaska*Unavailable$675.92
ArizonaUnavailable$531.19
ArkansasUnavailable$489.25
AtlantaUnavailable$561.48
AustinUnavailable$551.48
BakersfieldUnavailable$548.01
Baltimore/Surr. CntysUnavailable$578.79
BeaumontUnavailable$523.48
BrazoriaUnavailable$533.53

20690 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
20690 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 20690 rate is calculated

Each of 20690’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 · 20690

RVUs × geographic indexes × conversion factor

Work8.56

8.56 RVUs× 1.000 GPCI

Practice expense6.05

6.05 RVUs× 1.000 GPCI

Malpractice1.73

1.73 RVUs× 1.000 GPCI

Adjusted RVUs

16.3400

Conversion factor

$33.4009

Medicare rate

$545.77

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 20690

20690 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 20690

External fixation

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are 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.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 20690

External fixation

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

20690 without 51 · national facility

$545.77

External fixation

20690-51 · Second procedure: 50%

$272.89

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

20690 compared with similar codes

Compare codes · National

4 codes, side by side

  • 20690

    External fixation8.56 wRVU

    Not priced

  • 20692

    External fixation15.86 wRVU

    Not priced

  • 20696

    External fixation17.12 wRVU

    Not priced

  • 20650

    Skeletal traction2.22 wRVU

    $249.50

How to choose

20692External fixation
Choose 20690 for a single-plane external frame and 20692 for a frame with pins or wires in more than one plane.
20696External fixation
20696 describes a multiplanar external fixation system with stereotactic computer-assisted adjustments; 20690 is for single-plane fixation without that feature.
20650Skeletal traction
20650 covers insertion or removal of a bone pin or wire. It does not describe application of the unilateral external fixation system reported with 20690.

Codes related to 20690

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

Codes related to 20690
CodeHow it relatesNational office range
Same family
20692External fixationUnilateral external fixation application for a frame with pins or wires arranged in more than one plane.No office rate
Used instead
20696External fixationFor a multiplanar external fixation system with stereotactic computer-assisted adjustments.No office rate
20650Skeletal tractionFor insertion or removal of a bone pin or wire rather than application of an external fixation system.$220.41–$323.67

20690 billing questions

How does 20690 differ from 20692?

20690 is for a unilateral external frame with pins or wires in one plane. Use 20692 when the fixation is arranged in more than one plane.

Is 20690 reported per pin or wire?

No. Select the code based on the external fixation system's configuration, not the number of pins or wires. Document the frame arrangement in the operative report.

Can modifier 50 be used when both sides are treated?

No. CMS identifies bilateral adjustment as inappropriate for 20690. The descriptor and anatomy do not support modifier 50.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. The application and this related care are part of the surgical episode.

Can an assistant or co-surgeon be paid for 20690?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

How is 20690 paid when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.

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 20690PPRRVU2026_Oct_nonQPP.csv, line 1,784 (RVU26D)

Open CMS sourceHow we calculate rates

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