$80.33
Both address small joints or bursae; 20604 is selected when ultrasound guidance is used, while 20600 is for treatment without ultrasound guidance.
On this page
CMS RVU26D · Effective 2026-10-01
20600 Joint aspiration/injection Medicare reimbursement rates in Iowa
Reports aspiration and/or injection of a small joint or bursa, such as a finger or toe joint, when the service is performed without ultrasound guidance. Compare 20600 office and facility rates across CMS payment localities in Iowa.
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 20600 in Iowa?
Iowa 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
$51.78
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$29.16
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Joint procedures
About 20600: Small joint or bursa aspiration or injection
Reports aspiration and/or injection of a small joint or bursa, such as a finger or toe joint, when the service is performed without ultrasound guidance.
This service covers needle aspiration, injection, or both in a small joint or bursa without ultrasound guidance. Common sites include the metacarpophalangeal or interphalangeal joints of the hand and the joints of the toes. Orthopedists, rheumatologists, primary care clinicians, and other clinicians who treat joint symptoms may perform it in an office or facility setting. Aspiration may be performed to evaluate or relieve a small-joint effusion; injection may be used to treat a joint condition or local inflammation.
Select the code by the treated structure’s size and whether ultrasound guidance is used: use 20600 for a small joint or bursa without ultrasound, 20604 for the ultrasound-guided small-joint service, and different codes for intermediate or major structures. Document the site, laterality, indication, and aspiration or injection performed. The 0-day global period includes same-day preoperative and postoperative care. For bilateral treatment, modifier 50 is paid at 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 20600
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 procedure with modifier 50 is paid at 150%.
- 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 RVU0.64 · 38%
- Practice expense (office) RVU0.96 · 57%
- Malpractice RVU0.08 · 5%
436.6K
Medicare services in 2024 · #245 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.
20600 compared with similar codes
Office rates for Iowa, from the same CMS release.
$52.75
20605 is for an intermediate joint or bursa, such as the wrist or ankle; 20600 is for a small joint or bursa.
$62.89
20610 applies to a major joint or bursa, such as the knee or shoulder; 20600 applies to a small joint or bursa.
$62.41
20612 is for aspiration or injection of a ganglion cyst, rather than aspiration or injection of a small joint or bursa.
Compare 20600 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
Iowa →
Office / nonfacility
$51.78
Facility
$29.16
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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 20600 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
1,766
- Code
- 20600
- Physician work
- 0.64
- Practice expense
- 0.96
- Malpractice
- 0.08
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.64 | × 1.000 | 0.6400 |
| Practice expense | 0.96 | × 0.915 | 0.8784 |
| Malpractice | 0.08 | × 0.397 | 0.0318 |
| Total RVUs | 1.5502 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$51.78
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.64 | 1 |
| Practice expense | 0.96 | 0.915 |
| Malpractice | 0.08 | 0.397 |
(0.64 × 1 + 0.96 × 0.915 + 0.08 × 0.397) × $33.4009 = $51.78
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.64 | 1 |
| Practice expense | 0.22 | 0.915 |
| Malpractice | 0.08 | 0.397 |
(0.64 × 1 + 0.22 × 0.915 + 0.08 × 0.397) × $33.4009 = $29.16
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.
20600 billing questions
When should 20600 be chosen instead of 20604?
Use 20600 for a small joint or bursa treated without ultrasound guidance. When ultrasound guidance is used for the small-joint service, use 20604.
How is a small joint distinguished from an intermediate joint?
20600 is for small joints, such as finger or toe joints; 20605 is for an intermediate joint or bursa. Select based on the treated structure, not the medication injected.
Can aspiration and injection at the same small joint be reported separately?
The service includes aspiration, injection, or both at the treated small joint or bursa. Do not report separate units merely because both actions were performed at that site.
How should bilateral small-joint treatment be reported?
When the procedure is performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.
What documentation supports reporting 20600?
Identify the small joint or bursa, side, clinical reason, whether fluid was aspirated or medication injected, and that ultrasound guidance was not used.
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.
1,76320555,,Place ndl musc/tis for rt,A,,5.85,2.06,NA,2.06,,0.46,8.37,8.37,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,76420560,,Ndl insj w/o njx 1 or 2 musc,A,,0.31,0.42,,0.05,,0.01,0.74,0.37,0,XXX,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,76520561,,Ndl insj w/o njx 3+ musc,A,,0.47,0.64,,0.09,,0.03,1.14,0.59,0,XXX,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,76620600,,Drain/inj joint/bursa w/o us,A,,0.64,0.96,,0.22,,0.08,1.68,0.94,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,76720604,,Drain/inj joint/bursa w/us,A,,0.87,1.63,,0.21,,0.11,2.61,1.19,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,76820605,,Drain/inj joint/bursa w/o us,A,,0.66,0.97,,0.22,,0.08,1.71,0.96,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,76920606,,Drain/inj joint/bursa w/us,A,,0.98,1.72,,0.24,,0.12,2.82,1.34,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136