Billing code 20694: Fixator removalMedicare rate & RVUs
Removal of an external fixation frame under anesthesia, typically after fracture healing or completion of staged bone correction.
Medicare pays $461.93 for 20694 nationally in the office and $328.33 in a hospital or facility. Local office rates run $407.36–$595.96.
Medicare rate · 20694
Fixator removal
- Work RVUs
- 4.17
- Total RVUs
- 13.83
- Global days
- 090
National rate · 2026
$461.93
Office setting, before claim adjustments.
See every locality for 20694 →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 20694 covers
An orthopedic surgeon removes an external fixation system while the patient is under anesthesia. The device may stabilize a fracture, support an osteotomy, or maintain alignment during limb-lengthening or deformity correction. This service is commonly performed in an operating room or another setting where anesthesia is provided. It concerns removal of the external frame and its fixation elements, rather than removal of buried internal plates, screws, or other implants.
Report this code when the external fixation system is removed under anesthesia; documentation should identify the device, the reason for removal, and the work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted, and co-surgeon and team-surgery billing 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 20694 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
$407.36 to $595.96
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $413.45 | $296.55 |
| Alaska* | $538.98 | $396.70 |
| Arizona | $448.95 | $319.49 |
| Arkansas | $407.36 | $292.60 |
| Atlanta | $472.40 | $336.66 |
| Austin | $476.39 | $335.04 |
| Bakersfield | $482.71 | $336.28 |
| Baltimore/Surr. Cntys | $492.04 | $348.69 |
| Beaumont | $433.40 | $311.82 |
| Brazoria | $454.58 | $322.18 |
| Chicago | $498.56 | $364.29 |
| Chico | $480.50 | $334.07 |
| Colorado | $476.79 | $334.63 |
| Connecticut | $493.07 | $349.18 |
| Dallas | $458.26 | $325.19 |
| Dc + Md/Va Suburbs | $525.17 | $367.79 |
| Delaware | $456.41 | $324.41 |
| Detroit | $469.67 | $340.74 |
| East St. Louis | $464.99 | $342.07 |
| El Centro | $480.63 | $334.20 |
| Fort Lauderdale | $487.11 | $351.77 |
| Fort Worth | $455.64 | $323.90 |
| Fresno | $480.50 | $334.07 |
| Galveston | $456.44 | $323.77 |
| Hanford-Corcoran | $480.50 | $334.07 |
| Hawaii, Guam | $491.41 | $339.51 |
| Houston | $470.90 | $338.23 |
| Idaho | $424.33 | $301.41 |
| Indiana | $426.74 | $302.89 |
| Iowa | $420.84 | $298.59 |
| Kansas | $420.41 | $299.63 |
| Kentucky | $426.81 | $308.03 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $513.00 | $354.94 |
| Madera | $480.50 | $334.07 |
| Manhattan | $534.31 | $379.06 |
| Merced | $480.50 | $334.07 |
| Metropolitan Boston | $522.22 | $362.70 |
| Metropolitan Kansas City | $443.26 | $317.80 |
| Metropolitan Philadelphia | $481.68 | $342.60 |
| Metropolitan St. Louis | $447.77 | $320.58 |
| Miami | $514.43 | $375.35 |
| Minnesota | $451.95 | $314.47 |
| Mississippi | $413.87 | $298.83 |
| Modesto | $480.50 | $334.07 |
| Montana** | $461.88 | $328.28 |
| Napa | $551.94 | $375.85 |
| Nebraska | $422.71 | $299.39 |
| Nevada** | $457.82 | $324.09 |
| New Hampshire | $470.78 | $331.70 |
| New Mexico | $442.65 | $320.13 |
| New Orleans | $448.04 | $322.32 |
| North Carolina | $432.56 | $307.91 |
| North Dakota** | $446.26 | $312.66 |
| Northern Nj | $519.91 | $364.93 |
| Nyc Suburbs/Long Island | $549.46 | $390.60 |
| Ohio | $436.37 | $314.39 |
| Oklahoma | $424.35 | $305.04 |
| Oxnard-Thousand Oaks-Ventura | $509.81 | $351.89 |
| Portland | $490.29 | $341.86 |
| Poughkpsie/N Nyc Suburbs | $501.89 | $355.59 |
| Puerto Rico | $464.80 | $329.72 |
| Queens | $536.43 | $378.51 |
| Redding | $480.50 | $334.07 |
| Rest Of California | $480.50 | $334.07 |
| Rest Of Florida | $462.17 | $334.45 |
| Rest Of Georgia | $435.00 | $315.83 |
| Rest Of Illinois | $451.02 | $329.03 |
| Rest Of Louisiana | $426.76 | $308.52 |
| Rest Of Maine | $428.26 | $305.34 |
| Rest Of Maryland | $464.72 | $329.51 |
| Rest Of Massachusetts | $474.51 | $333.82 |
| Rest Of Michigan | $439.56 | $317.58 |
| Rest Of Missouri | $420.36 | $305.20 |
| Rest Of New Jersey | $497.32 | $351.43 |
| Rest Of New York | $439.28 | $312.36 |
| Rest Of Oregon | $452.91 | $319.84 |
| Rest Of Pennsylvania | $436.19 | $313.54 |
| Rest Of Texas | $444.27 | $317.48 |
| Rest Of Washington | $473.14 | $332.46 |
| Rhode Island | $471.51 | $333.50 |
| Riverside-San Bernardino-Ontario | $489.00 | $342.57 |
| Sacramento-Roseville-Folsom | $503.00 | $347.62 |
| Salinas | $501.12 | $346.27 |
| San Diego-Chula Vista-Carlsbad | $512.10 | $352.31 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $582.36 | $393.98 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $581.46 | $393.08 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $595.96 | $403.31 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $592.29 | $399.64 |
| San Luis Obispo-Paso Robles | $493.24 | $341.07 |
| Santa Cruz-Watsonville | $516.31 | $353.98 |
| Santa Maria-Santa Barbara | $502.77 | $346.99 |
| Santa Rosa-Petaluma | $521.42 | $357.35 |
| Seattle (King Cnty) | $531.32 | $367.39 |
| South Carolina | $435.46 | $312.01 |
| South Dakota** | $444.41 | $310.81 |
| Southern Maine | $449.53 | $317.13 |
| Stockton | $480.50 | $334.07 |
| Suburban Chicago | $491.28 | $354.07 |
| Tennessee | $422.76 | $301.31 |
| Utah | $441.47 | $315.88 |
| Vallejo | $550.65 | $374.56 |
| Vermont | $445.94 | $313.67 |
| Virgin Islands | $464.80 | $329.72 |
| Virginia | $449.14 | $317.81 |
| Visalia | $480.50 | $334.07 |
| West Virginia | $434.50 | $318.39 |
| Wisconsin | $431.23 | $303.24 |
| Wyoming** | $455.07 | $321.47 |
| Yuba City | $480.50 | $334.07 |
20694 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$407.36
$538.98
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 | $538.98 | 1 |
| AL | $413.45 | 1 |
| AR | $407.36 | 1 |
| AZ | $448.95 | 1 |
| CA | $480.50–$595.96 | 29 |
| CO | $476.79 | 1 |
| CT | $493.07 | 1 |
| DC | $525.17 | 1 |
| DE | $456.41 | 1 |
| FL | $462.17–$514.43 | 3 |
| GA | $435.00–$472.40 | 2 |
| GU | $491.41 | 1 |
| HI | $491.41 | 1 |
| IA | $420.84 | 1 |
| ID | $424.33 | 1 |
| IL | $451.02–$498.56 | 4 |
| IN | $426.74 | 1 |
| KS | $420.41 | 1 |
| KY | $426.81 | 1 |
| LA | $426.76–$448.04 | 2 |
| MA | $474.51–$522.22 | 2 |
| MD | $464.72–$525.17 | 3 |
| ME | $428.26–$449.53 | 2 |
| MI | $439.56–$469.67 | 2 |
| MN | $451.95 | 1 |
| MO | $420.36–$447.77 | 3 |
| MS | $413.87 | 1 |
| MT | $461.88 | 1 |
| NC | $432.56 | 1 |
| ND | $446.26 | 1 |
| NE | $422.71 | 1 |
| NH | $470.78 | 1 |
| NJ | $497.32–$519.91 | 2 |
| NM | $442.65 | 1 |
| NV | $457.82 | 1 |
| NY | $439.28–$549.46 | 5 |
| OH | $436.37 | 1 |
| OK | $424.35 | 1 |
| OR | $452.91–$490.29 | 2 |
| PA | $436.19–$481.68 | 2 |
| PR | $464.80 | 1 |
| RI | $471.51 | 1 |
| SC | $435.46 | 1 |
| SD | $444.41 | 1 |
| TN | $422.76 | 1 |
| TX | $433.40–$476.39 | 8 |
| UT | $441.47 | 1 |
| VA | $449.14–$525.17 | 2 |
| VI | $464.80 | 1 |
| VT | $445.94 | 1 |
| WA | $473.14–$531.32 | 2 |
| WI | $431.23 | 1 |
| WV | $434.50 | 1 |
| WY | $455.07 | 1 |
How the 20694 rate is calculated
Each of 20694’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 · 20694
RVUs × geographic indexes × conversion factor
Work4.17
4.17 RVUs× 1.000 GPCI
Practice expense8.87
8.87 RVUs× 1.000 GPCI
Malpractice0.79
0.79 RVUs× 1.000 GPCI
Adjusted RVUs
13.8300
Conversion factor
$33.4009
Medicare rate
$461.93
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20694
20694 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20694
Fixator removal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 20694
Fixator removal
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
20694 without 51 · national office
$461.93
Fixator removal
20694-51 · Second procedure: 50%
$230.97
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%).
20694 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 20693Fixator adjustment
- 20694 is for taking off the external fixation system under anesthesia. Choose 20693 when the system is adjusted or revised and remains in place.
- 20665Cranial device removal
- 20665 identifies removal of cranial tongs or a halo. Use 20694 for removal of an external fixation system.
- 20670Implant removal
- 20670 concerns superficial internal implant removal, such as accessible buried fixation material. It is not the code for removal of an external frame.
- 20680Implant removal
- 20680 concerns deep internal implant removal, such as buried plates or screws; 20694 concerns an external fixation system removed under anesthesia.
20694 billing questions
When should this code be chosen instead of 20693?
Use 20694 when the external fixation system is removed under anesthesia. Code 20693 describes adjustment or revision of the system under anesthesia when it remains in place.
Is this the code for removing buried plates or screws?
No. It covers removal of an external fixation system. Codes 20670 and 20680 concern removal of superficial and deep internal implants, respectively.
Can modifier 50 be used when fixators are removed on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service according to the documented procedure rather than appending modifier 50.
What documentation supports reporting 20694?
Document the external fixation device, the clinical reason for removal, that removal was performed under anesthesia, and the operative work completed.
How does the 90-day global period affect follow-up billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant surgeon or co-surgeon be reported?
CMS lists a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are not permitted.
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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