No office rate
20694 is for taking off the external fixation system under anesthesia. Choose 20693 when the system is adjusted or revised and remains in place.
On this page
CMS RVU26D · Effective 2026-10-01
20694 Fixator removal Medicare reimbursement rates in Alabama
Removal of an external fixation frame under anesthesia, typically after fracture healing or completion of staged bone correction. Compare 20694 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 20694 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$413.45
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
$296.55
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic surgery
About 20694: External fixation system removal under anesthesia
Removal of an external fixation frame under anesthesia, typically after fracture healing or completion of staged bone correction.
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.
CMS billing rules for 20694
- 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 RVU4.17 · 30%
- Practice expense (office) RVU8.87 · 64%
- Malpractice RVU0.79 · 6%
5.2K
Medicare services in 2024 · #1843 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.
20694 compared with similar codes
Office rates for Alabama, from the same CMS release.
$107.58
20665 identifies removal of cranial tongs or a halo. Use 20694 for removal of an external fixation system.
$328.63
20670 concerns superficial internal implant removal, such as accessible buried fixation material. It is not the code for removal of an external frame.
$566.27
20680 concerns deep internal implant removal, such as buried plates or screws; 20694 concerns an external fixation system removed under anesthesia.
Compare 20694 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
$413.45
Facility
$296.55
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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 20694 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
1,787
- Code
- 20694
- Physician work
- 4.17
- Practice expense
- 8.87
- Malpractice
- 0.79
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.17 | × 1.000 | 4.1700 |
| Practice expense | 8.87 | × 0.875 | 7.7612 |
| Malpractice | 0.79 | × 0.566 | 0.4471 |
| Total RVUs | 12.3784 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$413.45
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.17 | 1 |
| Practice expense | 8.87 | 0.875 |
| Malpractice | 0.79 | 0.566 |
(4.17 × 1 + 8.87 × 0.875 + 0.79 × 0.566) × $33.4009 = $413.45
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.17 | 1 |
| Practice expense | 4.87 | 0.875 |
| Malpractice | 0.79 | 0.566 |
(4.17 × 1 + 4.87 × 0.875 + 0.79 × 0.566) × $33.4009 = $296.55
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.
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 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.
1,78420690,,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
1,79020700,,Mnl prep&insj dp rx dlvr dev,A,,1.46,0.82,,0.40,,0.26,2.54,2.12,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515