Billing code 20611: Joint aspiration/injectionMedicare rate & RVUs in Guam
Needle aspiration, injection, or both into a major joint or bursa, such as the knee, shoulder, or hip, under ultrasound guidance with a recorded image and report.
Medicare pays $110.98 for 20611 in the office in Guam (Hawaii, Guam). 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 20611 covers
This service covers aspiration or injection of a major joint or bursa, typically the knee, shoulder, hip, or subacromial bursa, with real-time ultrasound used to direct the needle. Common indications include corticosteroid or viscosupplement injection for osteoarthritis, aspiration of a knee effusion to evaluate for gout or infection, and subacromial injection for impingement. Orthopedists, sports medicine physicians, rheumatologists, physiatrists, and advanced practice providers perform it, mainly in offices.
Ultrasound guidance is built into the code, so a separate guidance code is not reported. Documentation should identify the joint or bursa, laterality, drug and dose or fluid volume removed, and include permanent recording and reporting of the ultrasound guidance. Without that recording and reporting, the unguided major joint code applies. The 0-day global period includes same-day preoperative and postoperative care; a significant, separately identifiable E/M service needs modifier 25. Bilateral procedures reported with modifier 50 are paid at 150%. For multiple procedures in one session, the highest-valued is paid in full and others at 50%. Assistant-at-surgery payment is statutorily restricted; 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.
20611 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $110.98 | $49.46 |
How the 20611 rate is calculated
Each of 20611’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 · 20611
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.07Practice expense 1.91Malpractice 0.14
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 20611
The CMS indicators that decide how 20611 is paid alongside other services.
CMS payment indicators · 20611
Joint aspiration/injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
20611 without 50 · national office
$104.21
Joint aspiration/injection
20611-50 · Bilateral: 150%
$156.31
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
20611 compared with similar codes
Compare codes
20611 vs 20610 vs 20606 vs 76942 vs 20604: national Medicare rates
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How to choose
- 20610Joint injection
- Use 20610 when the major joint is injected or aspirated by landmarks, or when ultrasound guidance was used but not permanently recorded and reported. 20611 requires recorded and reported ultrasound guidance.
- 20606Joint aspiration
- 20606 is for intermediate sites like the wrist, elbow, ankle, or olecranon bursa under ultrasound guidance. Choose 20611 for major sites such as the knee, shoulder, hip, or subacromial bursa.
- 76942Ultrasound needle guidance
- 76942 is ultrasound needle guidance billed with procedures that do not include imaging guidance. It is not added to 20611 because guidance is included.
- 20604Joint aspiration or injection
- 20604 covers small joints and bursae, such as finger or toe joints, with ultrasound guidance; 20611 covers major joints and bursae.
20611 billing questions
Can 76942 be reported with 20611 for the ultrasound guidance?
No. Ultrasound guidance is included in 20611, so 76942 is not separately reported for the same procedure. If guidance was used but not permanently recorded and reported, report 20610 instead.
How are bilateral knee injections under ultrasound reported?
Report 20611 with modifier 50 on one line for Medicare, which pays the bilateral procedure at 150%. Document guidance, images, and the drug for each side.
Is the injected drug included?
When the practice supplies the drug, it may be billed separately with the appropriate HCPCS code, such as J3301 for triamcinolone acetonide. Match HCPCS units to the documented administered dose.
When can an office visit be billed on the same day?
A significant, separately identifiable E/M service beyond the routine pre-injection assessment may be reported with modifier 25. Same-day preoperative and postoperative care for the injection is included in the 0-day global period.
Which joints qualify as major joints for this code?
Major sites include the knee, shoulder, hip, and subacromial bursa. The wrist, elbow, ankle, and olecranon bursa are intermediate sites; finger and toe joints are small sites.
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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