$144.95
20501 describes a diagnostic injection used to evaluate or outline a sinus tract; 20500 is for therapeutic treatment through the tract.
On this page
CMS RVU26D · Effective 2026-10-01
20500 Sinus tract injection Medicare reimbursement rates in Connecticut
Report this service when a clinician injects a therapeutic agent into an existing sinus tract to treat the tract, rather than to map it diagnostically. Compare 20500 office and facility rates across CMS payment localities in Connecticut.
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 20500 in Connecticut?
Connecticut 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
$136.78
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$88.22
1 of 1 localities have a supported rate.
Payment area: Connecticut
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.
Injection procedure
About 20500: Therapeutic sinus tract injection
Report this service when a clinician injects a therapeutic agent into an existing sinus tract to treat the tract, rather than to map it diagnostically.
A clinician directs a therapeutic injection into an existing sinus tract. The defining feature is treatment through the tract itself, not an injection into nearby tissue or a study intended to show the tract’s course. The service may be performed in an office or facility by a physician or other qualified practitioner managing the tract. The record should identify the tract, the therapeutic purpose, the material delivered, and the technique used.
Choose this code based on therapeutic intent; use the diagnostic sinus-tract injection code when the injection is performed to evaluate or outline the tract. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is inappropriate for this descriptor and anatomy. CMS does not pay for an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 20500
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU1.25 · 32%
- Practice expense (office) RVU2.45 · 64%
- Malpractice RVU0.15 · 4%
416
Medicare services in 2024 · #3705 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.
20500 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$64.12
20550 targets a tendon sheath or ligament, not a sinus tract.
$64.08
20551 targets a tendon origin or insertion; use 20500 when the therapeutic injection is directed into a sinus tract.
Compare 20500 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
Connecticut →
Office / nonfacility
$136.78
Facility
$88.22
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 20500 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
1,752
- Code
- 20500
- Physician work
- 1.25
- Practice expense
- 2.45
- Malpractice
- 0.15
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.25 | × 1.020 | 1.2750 |
| Practice expense | 2.45 | × 1.077 | 2.6387 |
| Malpractice | 0.15 | × 1.210 | 0.1815 |
| Total RVUs | 4.0952 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$136.78
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.25 | 1.02 |
| Practice expense | 2.45 | 1.077 |
| Malpractice | 0.15 | 1.21 |
(1.25 × 1.02 + 2.45 × 1.077 + 0.15 × 1.21) × $33.4009 = $136.78
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.25 | 1.02 |
| Practice expense | 1.1 | 1.077 |
| Malpractice | 0.15 | 1.21 |
(1.25 × 1.02 + 1.1 × 1.077 + 0.15 × 1.21) × $33.4009 = $88.22
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.
20500 billing questions
How is this distinguished from code 20501?
Use 20500 when the injection treats the sinus tract. Use 20501 when the injection is diagnostic and intended to evaluate or outline it.
What should the procedure note include?
Document the sinus tract treated, the therapeutic intent, the material injected, and how it was delivered into the tract.
Can modifier 50 be reported for bilateral treatment?
No. The descriptor and anatomy make modifier 50 inappropriate.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and applies a 50% reduction to the other procedures.
Can an assistant, co-surgeon, or surgical team be billed?
CMS does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing 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.
1,7492035F,,Tymp memb motion examd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7502040F,,Bk pn xm on init visit date,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7512044F,,Doc mntl tst b/4 bk trxmnt,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,75220500,,Njx sinus tract therapeutic,A,,1.25,2.45,,1.10,,0.15,3.85,2.50,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,75320501,,Njx sinus tract diagnostic,A,,0.74,3.25,,0.12,,0.07,4.06,0.93,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7542050F,,Wound char size etc docd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,75520520,,Rmvl fb musc/tdn simple,A,,1.85,4.76,,2.13,,0.27,6.88,4.25,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
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