Billing code 20650: Skeletal tractionMedicare rate & RVUs in Georgia
Reports placement of a wire or pin into bone to establish skeletal traction, such as temporary traction for selected fractures, including pin removal when performed.
Medicare pays $234.37–$254.88 for 20650 in the office in Georgia, from Rest Of Georgia to Atlanta. Which amount applies depends on the service address.
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 20650 covers
An orthopedic surgeon places a wire or pin through bone and connects it to a traction setup to apply controlled pulling force. A typical use is temporary skeletal traction during management of a fracture when traction through a pin is needed. The service may be performed in a hospital or another setting where the clinician can place and manage the traction apparatus. The code includes removal of the traction wire or pin when performed.
Report the service when documentation identifies the bone and insertion site, the clinical reason for skeletal traction, and the pin or wire placement and traction application. The 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation, and team surgery is 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 20650 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | $254.88 | $163.93 |
| Rest Of Georgia | $234.37 | $154.53 |
How the 20650 rate is calculated
Each of 20650’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 · 20650
RVUs × geographic indexes × conversion factor
Work2.22
2.22 RVUs× 1.000 GPCI
Practice expense4.87
4.87 RVUs× 1.000 GPCI
Malpractice0.38
0.38 RVUs× 1.000 GPCI
Adjusted RVUs
7.4700
Conversion factor
$33.4009
Medicare rate
$249.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20650
20650 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 20650
Skeletal traction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 20650
Skeletal traction
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
20650 without 51 · national office
$249.50
Skeletal traction
20650-51 · Second procedure: 50%
$124.75
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%).
20650 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 20660Cranial traction
- 20650 uses a wire or pin inserted into bone to apply skeletal traction. 20660 is for application of cranial tongs, calipers, or another cranial fixation device.
- 20661Cranial halo
- 20661 describes application of a cranial halo. Choose 20650 for traction established by a wire or pin inserted into bone rather than a halo device.
- 20690External fixation
- 20690 describes application of a uniplanar external fixation system. It is not the code for a bone pin used to apply skeletal traction.
20650 billing questions
How is 20650 different from cranial tongs or a halo?
20650 describes skeletal traction established with a wire or pin inserted into bone. Cranial tongs and halo services use different fixation devices and are reported with their respective codes.
Can pin removal be billed separately?
Removal of the traction wire or pin is included when performed as part of this service. The code does not describe removal of a separate, previously placed implant.
Should modifier 50 be appended for pins on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What documentation supports reporting 20650?
Record the indication for skeletal traction, the bone and insertion site, the wire or pin placement, and the traction applied. Document removal when it is performed.
How are other procedures in the same session paid?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures in that session are subject to the reduction. Related postoperative visits are included for 10 days.
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
Fee sheets
Put 20650 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →