No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
20650 Skeletal traction Medicare reimbursement rates in Hawaii
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. Compare 20650 office and facility rates across CMS payment localities in Hawaii.
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 20650 in Hawaii?
Hawaii 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
$266.45
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$164.67
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 procedure
About 20650: Bone pin insertion for skeletal traction
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.
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.
CMS billing rules for 20650
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.22 · 30%
- Practice expense (office) RVU4.87 · 65%
- Malpractice RVU0.38 · 5%
894
Medicare services in 2024 · #3050 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.
20650 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
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.
No office rate
20690 describes application of a uniplanar external fixation system. It is not the code for a bone pin used to apply skeletal traction.
Compare 20650 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
Hawaii, Guam →
Office / nonfacility
$266.45
Facility
$164.67
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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 20650 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,775
- Code
- 20650
- Physician work
- 2.22
- Practice expense
- 4.87
- Malpractice
- 0.38
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.22 | × 1.000 | 2.2200 |
| Practice expense | 4.87 | × 1.137 | 5.5372 |
| Malpractice | 0.38 | × 0.579 | 0.2200 |
| Total RVUs | 7.9772 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$266.45
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.22 | 1 |
| Practice expense | 4.87 | 1.137 |
| Malpractice | 0.38 | 0.579 |
(2.22 × 1 + 4.87 × 1.137 + 0.38 × 0.579) × $33.4009 = $266.45
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.22 | 1 |
| Practice expense | 2.19 | 1.137 |
| Malpractice | 0.38 | 0.579 |
(2.22 × 1 + 2.19 × 1.137 + 0.38 × 0.579) × $33.4009 = $164.67
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.
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 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.
1,77220611,,Drain/inj joint/bursa w/us,A,,1.07,1.91,,0.29,,0.14,3.12,1.50,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,77320612,,Aspirate/inj ganglion cyst,A,,0.68,1.26,,0.33,,0.09,2.03,1.10,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,77420615,,Treatment of bone cyst,A,,2.27,4.95,,1.80,,0.25,7.47,4.32,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,77520650,,Insert and remove bone pin,A,,2.22,4.87,,2.19,,0.38,7.47,4.79,0,010,0.10,0.80,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,77620660,,Apply rem fixation device,A,,3.90,1.27,NA,1.27,,1.26,6.43,6.43,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,77720661,,Application halo cranial,A,,5.13,9.68,NA,9.68,,1.76,16.57,16.57,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,77820662,,Application halo pelvic,A,,6.22,7.46,NA,7.46,,1.32,15.00,15.00,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014