$408.12
20670 is for superficial implants. Choose 20680 when hardware is deeply buried and requires operative exposure and dissection.
On this page
CMS RVU26D · Effective 2026-10-01
20680 Implant removal Medicare reimbursement rates in Hawaii
Reports operative removal of deeply buried orthopedic hardware, such as a plate, screw, or rod, when removal is a distinct surgical service. Compare 20680 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 20680 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
$672.18
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$402.16
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 surgery
About 20680: Deep orthopedic implant removal
Reports operative removal of deeply buried orthopedic hardware, such as a plate, screw, or rod, when removal is a distinct surgical service.
An orthopedic surgeon typically reports this service when removing hardware buried beneath soft tissue or bone, such as a plate and screws or an intramedullary rod. Removal may require an incision and dissection to expose the implant. It is performed in settings ranging from an operating room to a procedure room when the depth and complexity are suitable. The operative report should identify the implant, its anatomic site, and the work needed to reach and remove it.
Choose this code for deep hardware rather than a superficial implant removable with less extensive exposure. Report it for a distinct removal service, not merely to describe hardware taken out as an integral part of another operation. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 20680
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.81 · 31%
- Practice expense (office) RVU12.05 · 64%
- Malpractice RVU1.06 · 6%
59.9K
Medicare services in 2024 · #715 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.
20680 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$491.41
20694 describes removal of an external fixation system under anesthesia; 20680 concerns a deeply implanted device rather than an external frame.
No office rate
22852 is the specific removal code for segmental posterior spinal instrumentation. Use it rather than 20680 when that spinal instrumentation is removed.
Compare 20680 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
$672.18
Facility
$402.16
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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 20680 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,783
- Code
- 20680
- Physician work
- 5.81
- Practice expense
- 12.05
- Malpractice
- 1.06
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.81 | × 1.000 | 5.8100 |
| Practice expense | 12.05 | × 1.137 | 13.7009 |
| Malpractice | 1.06 | × 0.579 | 0.6137 |
| Total RVUs | 20.1246 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$672.18
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.81 | 1 |
| Practice expense | 12.05 | 1.137 |
| Malpractice | 1.06 | 0.579 |
(5.81 × 1 + 12.05 × 1.137 + 1.06 × 0.579) × $33.4009 = $672.18
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.81 | 1 |
| Practice expense | 4.94 | 1.137 |
| Malpractice | 1.06 | 0.579 |
(5.81 × 1 + 4.94 × 1.137 + 1.06 × 0.579) × $33.4009 = $402.16
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.
20680 billing questions
How does this differ from 20670?
Use 20680 for deeply buried hardware requiring operative exposure and dissection. Code 20670 describes removal of a superficial implant.
Can removal be reported with a reconstruction at the same site?
Removal may be separately reported when it is a distinct service rather than an integral step in the reconstruction. Document the separate removal work and check applicable code edits.
Is modifier 50 appropriate when hardware is removed on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
Does the code count each screw or plate component?
Do not treat every screw or component as a separate unit. Document the implant site and distinct removal work performed.
When can an assistant be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. 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 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.
1,78020664,,Appl halo cranial 6+pins,A,,9.81,14.26,NA,14.26,,4.13,28.20,28.20,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78120665,,Rmvl tongs/halo anthr indiv,A,,1.33,2.09,,1.13,,0.11,3.53,2.57,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78220670,,Removal implant superficial,A,,1.75,9.07,,2.17,,0.27,11.09,4.19,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78320680,,Removal of implant deep,A,,5.81,12.05,,4.94,,1.06,18.92,11.81,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78420690,,Appl unipln uni ext fixj sys,A,,8.56,6.05,NA,6.05,,1.73,16.34,16.34,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78520692,,Appl mltpln uni ext fixj sys,A,,15.86,12.56,NA,12.56,,2.93,31.35,31.35,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78620693,,Adjmt/revj ext fixj sys anes,A,,5.91,5.91,NA,5.91,,1.05,12.87,12.87,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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