Billing code 20664: Cranial haloMedicare rate & RVUs in Alaska
Reports application and removal of a cranial halo using six or more pins to immobilize the head and cervical spine, such as for fracture stabilization.
CMS doesn’t publish an office rate for 20664 in Alaska.
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 9 sections
What 20664 covers
This service covers applying a cranial halo secured with six or more pins and its removal. Orthopedic spine surgeons and neurosurgeons may use the device to immobilize the head and cervical spine, including during treatment of a cervical fracture or instability. The service may be performed in a hospital or another setting equipped for the procedure.
Select the code when the documented device is a cranial halo and the pin count meets the six-or-more threshold; cranial tongs and halos with different configurations have distinct coding. The operative record should identify the device, pin count, indication, and work performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code, and 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.
20664 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $1,074.76 |
How the 20664 rate is calculated
Each of 20664’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 · 20664
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.81Practice expense 14.26Malpractice 4.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 20664
20664 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20664
Cranial halo
| 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 · 20664
Cranial halo
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
20664 without 51 · national facility
$941.91
Cranial halo
20664-51 · Second procedure: 50%
$470.96
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%).
20664 compared with similar codes
Compare codes
20664 vs 20660 vs 20661 vs 20665 vs 20690: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 20660Cranial traction
- 20660 describes cranial tongs, a caliper, or another halo-type device. Use 20664 for a cranial halo secured with six or more pins.
- 20661Cranial halo
- Both codes concern cranial halo application. 20664 is distinguished by the six-or-more-pin threshold.
- 20665Cranial device removal
- 20665 describes separate removal of cranial tongs or a halo. Removal included in the 20664 service is not separately reported with it.
- 20690External fixation
- 20690 describes application of a uniplanar external fixation system, not cranial halo immobilization.
20664 billing questions
How is this code distinguished from 20660?
Use 20664 for a cranial halo with six or more pins. Code 20660 describes application of cranial tongs, a caliper, or another halo-type device.
Is halo removal reported separately?
Removal is included in the cranial halo service. Do not separately report 20665 for removal that is part of the same service.
Does modifier 50 apply if both sides of the skull are involved?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 is not used.
What documentation supports choosing this code?
The operative documentation should identify a cranial halo, establish that six or more pins were used, and describe the indication and procedure.
How does the multiple-procedure payment rule affect this service?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery 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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