No office rate
Use 20690 for initial application of a uniplane external fixation system. Use 20693 for adjustment or revision of an existing system requiring anesthesia.
On this page
CMS RVU26D · Effective 2026-10-01
20693 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$424.95
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Orthopedic surgery
About 20693: External fixation system adjustment under anesthesia
Report this service when a surgeon adjusts or revises an existing external fixation system and the work requires anesthesia, rather than initial device placement or removal.
An orthopedic surgeon reports this service for adjustment or revision of an external fixation system when anesthesia is required. The work may address fracture alignment or correct a deformity using an existing frame. It is distinct from applying a new external fixator or removing the system. These procedures are commonly performed in an operating room or another setting equipped to provide anesthesia and manage the fixation device.
Select the code based on the documented adjustment or revision and the need for anesthesia. The operative record should identify the existing fixation system, the change made, the clinical purpose, and the anesthesia requirement. CMS assigns a 90-day global period, including 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 multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 20693
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.91 · 46%
- Practice expense (office) RVU5.91 · 46%
- Malpractice RVU1.05 · 8%
476
Medicare services in 2024 · #3607 by national volume
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.
20693 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
Use 20692 for initial application of a multiplane external fixation system. It does not describe adjustment or revision of an existing system.
$456.41
Use 20694 when the external fixation system is removed under anesthesia. Use 20693 when the service adjusts or revises the system instead.
No office rate
20696 describes initial application of a multiplane system with stereotactic computer-assisted adjustment; 20693 describes adjustment or revision of an existing system requiring anesthesia.
The same code, a different location
How does Delaware compare?
20693 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Alabama
Alabama · 20693
Office
Unavailable
Facility
$389.97
No comparable office rate is available.
Arkansas
Arkansas · 20693
Office
Unavailable
Facility
$385.03
No comparable office rate is available.
Arizona
Arizona · 20693
Office
Unavailable
Facility
$418.70
No comparable office rate is available.
Bakersfield
California · 20693
Office
Unavailable
Facility
$438.86
No comparable office rate is available.
Chico
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
El Centro
California · 20693
Office
Unavailable
Facility
$436.08
No comparable office rate is available.
Fresno
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Hanford-Corcoran
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Madera
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Merced
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Modesto
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Napa
California · 20693
Office
Unavailable
Facility
$487.82
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 20693
Office
Unavailable
Facility
$458.10
No comparable office rate is available.
Redding
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Rest Of California
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 20693
Office
Unavailable
Facility
$447.22
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 20693
Office
Unavailable
Facility
$452.88
No comparable office rate is available.
Salinas
California · 20693
Office
Unavailable
Facility
$451.10
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 20693
Office
Unavailable
Facility
$458.42
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 20693
Office
Unavailable
Facility
$510.58
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 20693
Office
Unavailable
Facility
$509.39
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 20693
Office
Unavailable
Facility
$522.56
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 20693
Office
Unavailable
Facility
$517.69
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 20693
Office
Unavailable
Facility
$444.39
No comparable office rate is available.
Santa Cruz-Watsonville
California · 20693
Office
Unavailable
Facility
$460.18
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 20693
Office
Unavailable
Facility
$451.89
No comparable office rate is available.
Santa Rosa-Petaluma
California · 20693
Office
Unavailable
Facility
$464.53
No comparable office rate is available.
Stockton
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Vallejo
California · 20693
Office
Unavailable
Facility
$486.11
No comparable office rate is available.
Visalia
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Yuba City
California · 20693
Office
Unavailable
Facility
$435.90
No comparable office rate is available.
Colorado
Colorado · 20693
Office
Unavailable
Facility
$437.19
No comparable office rate is available.
Connecticut
Connecticut · 20693
Office
Unavailable
Facility
$456.38
No comparable office rate is available.
Fort Lauderdale
Florida · 20693
Office
Unavailable
Facility
$460.77
No comparable office rate is available.
Rest Of Florida
Florida · 20693
Office
Unavailable
Facility
$438.82
No comparable office rate is available.
Atlanta
Georgia · 20693
Office
Unavailable
Facility
$440.67
No comparable office rate is available.
Rest Of Georgia
Georgia · 20693
Office
Unavailable
Facility
$415.28
No comparable office rate is available.
Hawaii, Guam
Hawaii · 20693
Office
Unavailable
Facility
$442.15
No comparable office rate is available.
Iowa
Iowa · 20693
Office
Unavailable
Facility
$391.94
No comparable office rate is available.
Idaho
Idaho · 20693
Office
Unavailable
Facility
$395.60
No comparable office rate is available.
East St. Louis
Illinois · 20693
Office
Unavailable
Facility
$449.64
No comparable office rate is available.
Rest Of Illinois
Illinois · 20693
Office
Unavailable
Facility
$432.44
No comparable office rate is available.
Suburban Chicago
Illinois · 20693
Office
Unavailable
Facility
$463.66
No comparable office rate is available.
Indiana
Indiana · 20693
Office
Unavailable
Facility
$397.43
No comparable office rate is available.
Kansas
Kansas · 20693
Office
Unavailable
Facility
$393.52
No comparable office rate is available.
Kentucky
Kentucky · 20693
Office
Unavailable
Facility
$404.98
No comparable office rate is available.
New Orleans
Louisiana · 20693
Office
Unavailable
Facility
$422.99
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 20693
Office
Unavailable
Facility
$405.70
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 20693
Office
Unavailable
Facility
$472.40
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 20693
Office
Unavailable
Facility
$436.37
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 20693
Office
Unavailable
Facility
$455.75
No comparable office rate is available.
Rest Of Maryland
Maryland · 20693
Office
Unavailable
Facility
$431.34
No comparable office rate is available.
Rest Of Maine
Maine · 20693
Office
Unavailable
Facility
$400.82
No comparable office rate is available.
Southern Maine
Maine · 20693
Office
Unavailable
Facility
$415.15
No comparable office rate is available.
Detroit
Michigan · 20693
Office
Unavailable
Facility
$447.02
No comparable office rate is available.
Rest Of Michigan
Michigan · 20693
Office
Unavailable
Facility
$417.22
No comparable office rate is available.
Minnesota
Minnesota · 20693
Office
Unavailable
Facility
$410.90
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 20693
Office
Unavailable
Facility
$417.02
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 20693
Office
Unavailable
Facility
$420.46
No comparable office rate is available.
Rest Of Missouri
Missouri · 20693
Office
Unavailable
Facility
$401.72
No comparable office rate is available.
Mississippi
Mississippi · 20693
Office
Unavailable
Facility
$393.28
No comparable office rate is available.
Montana**
Montana · 20693
Office
Unavailable
Facility
$429.80
No comparable office rate is available.
North Carolina
North Carolina · 20693
Office
Unavailable
Facility
$403.98
No comparable office rate is available.
North Dakota**
North Dakota · 20693
Office
Unavailable
Facility
$409.04
No comparable office rate is available.
Nebraska
Nebraska · 20693
Office
Unavailable
Facility
$392.86
No comparable office rate is available.
New Hampshire
New Hampshire · 20693
Office
Unavailable
Facility
$433.58
No comparable office rate is available.
Northern Nj
New Jersey · 20693
Office
Unavailable
Facility
$476.27
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 20693
Office
Unavailable
Facility
$459.33
No comparable office rate is available.
New Mexico
New Mexico · 20693
Office
Unavailable
Facility
$420.53
No comparable office rate is available.
Nevada**
Nevada · 20693
Office
Unavailable
Facility
$424.21
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 20693
Office
Unavailable
Facility
$509.87
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 20693
Office
Unavailable
Facility
$464.87
No comparable office rate is available.
Queens
New York · 20693
Office
Unavailable
Facility
$493.93
No comparable office rate is available.
Rest Of New York
New York · 20693
Office
Unavailable
Facility
$409.58
No comparable office rate is available.
Ohio
Ohio · 20693
Office
Unavailable
Facility
$412.98
No comparable office rate is available.
Oklahoma
Oklahoma · 20693
Office
Unavailable
Facility
$400.93
No comparable office rate is available.
Portland
Oregon · 20693
Office
Unavailable
Facility
$445.96
No comparable office rate is available.
Rest Of Oregon
Oregon · 20693
Office
Unavailable
Facility
$418.66
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 20693
Office
Unavailable
Facility
$448.28
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 20693
Office
Unavailable
Facility
$411.75
No comparable office rate is available.
Puerto Rico
Puerto Rico · 20693
Office
Unavailable
Facility
$431.51
No comparable office rate is available.
Rhode Island
Rhode Island · 20693
Office
Unavailable
Facility
$436.35
No comparable office rate is available.
South Carolina
South Carolina · 20693
Office
Unavailable
Facility
$409.61
No comparable office rate is available.
South Dakota**
South Dakota · 20693
Office
Unavailable
Facility
$406.58
No comparable office rate is available.
Tennessee
Tennessee · 20693
Office
Unavailable
Facility
$395.67
No comparable office rate is available.
Austin
Texas · 20693
Office
Unavailable
Facility
$437.72
No comparable office rate is available.
Beaumont
Texas · 20693
Office
Unavailable
Facility
$409.61
No comparable office rate is available.
Brazoria
Texas · 20693
Office
Unavailable
Facility
$421.96
No comparable office rate is available.
Dallas
Texas · 20693
Office
Unavailable
Facility
$425.88
No comparable office rate is available.
Fort Worth
Texas · 20693
Office
Unavailable
Facility
$424.36
No comparable office rate is available.
Galveston
Texas · 20693
Office
Unavailable
Facility
$424.03
No comparable office rate is available.
Houston
Texas · 20693
Office
Unavailable
Facility
$443.25
No comparable office rate is available.
Rest Of Texas
Texas · 20693
Office
Unavailable
Facility
$416.40
No comparable office rate is available.
Utah
Utah · 20693
Office
Unavailable
Facility
$414.45
No comparable office rate is available.
Virginia
Virginia · 20693
Office
Unavailable
Facility
$416.20
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 20693
Office
Unavailable
Facility
$431.51
No comparable office rate is available.
Vermont
Vermont · 20693
Office
Unavailable
Facility
$410.57
No comparable office rate is available.
Rest Of Washington
Washington · 20693
Office
Unavailable
Facility
$434.52
No comparable office rate is available.
Seattle (King Cnty)
Washington · 20693
Office
Unavailable
Facility
$478.13
No comparable office rate is available.
Wisconsin
Wisconsin · 20693
Office
Unavailable
Facility
$397.31
No comparable office rate is available.
West Virginia
West Virginia · 20693
Office
Unavailable
Facility
$419.13
No comparable office rate is available.
Wyoming**
Wyoming · 20693
Office
Unavailable
Facility
$420.75
No comparable office rate is available.
See how rates vary across the country
20693 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 20693 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$467.45
$424.95 × 110% = $467.45
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 20693 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
1,786
- Code
- 20693
- Physician work
- 5.91
- Practice expense
- 5.91
- Malpractice
- 1.05
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.91 | × 1.005 | 5.9395 |
| Practice expense | 5.91 | × 0.988 | 5.8391 |
| Malpractice | 1.05 | × 0.899 | 0.9440 |
| Total RVUs | 12.7226 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$424.95
Open 20693 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.91 | 1.005 |
| Practice expense | 5.91 | 0.988 |
| Malpractice | 1.05 | 0.899 |
(5.91 × 1.005 + 5.91 × 0.988 + 1.05 × 0.899) × $33.4009 = $424.95
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
20693 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $424.95 | RVU26D |
| 2026-07-01 | Not available in this setting | $424.95 | RVU26C |
| 2026-04-01 | Not available in this setting | $424.95 | RVU26B |
| 2026-01-01 | Not available in this setting | $424.95 | RVU26A |
| 2025-10-01 | Not available in this setting | $445.05 | RVU25D |
| 2025-07-01 | Not available in this setting | $445.05 | RVU25C |
| 2025-04-01 | Not available in this setting | $445.05 | RVU25B |
| 2025-01-01 | Not available in this setting | $445.05 | RVU25A |
20693 billing questions
How does this differ from applying an external fixator?
This code is for adjustment or revision of an existing system requiring anesthesia. Codes 20690 and 20692 describe initial application of specified external fixation systems.
Can this code be used for removal of the frame?
No. Removal of an external fixation system under anesthesia is described by 20694. Report 20693 when the service is an adjustment or revision.
What documentation supports reporting 20693?
Document the existing external fixation system, the adjustment or revision performed, its clinical purpose, and that the service required anesthesia.
Can modifier 50 be reported for adjustment on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor, so modifier 50 should not be used.
How does the 90-day global period affect postoperative care?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. The service is treated as major surgery for this purpose.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted under the CMS rules provided.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,78320680,,Removal of implant deep,A,,5.81,12.05,,4.94,,1.06,18.92,11.81,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78420690,,Appl unipln uni ext fixj sys,A,,8.56,6.05,NA,6.05,,1.73,16.34,16.34,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78520692,,Appl mltpln uni ext fixj sys,A,,15.86,12.56,NA,12.56,,2.93,31.35,31.35,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78620693,,Adjmt/revj ext fixj sys anes,A,,5.91,5.91,NA,5.91,,1.05,12.87,12.87,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78720694,,Rmvl ext fixj sys under anes,A,,4.17,8.87,,4.87,,0.79,13.83,9.83,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78820696,,App mltpln uni xtrnl fix 1st,A,,17.12,11.66,NA,11.66,,3.01,31.79,31.79,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78920697,,App mltpln uni xtrnl fix xch,A,,0.00,57.17,,57.17,NA,0.03,57.20,57.20,3,000,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503