$52.75
Both describe an intermediate-joint or bursa procedure. Report 20606 when ultrasound guidance with image recording and reporting is used; report 20605 for the procedure without that guidance.
On this page
CMS RVU26D · Effective 2026-10-01
20606 Joint aspiration Medicare reimbursement rates in Iowa
Reports aspiration, injection, or both for an intermediate joint or bursa when ultrasound guides needle placement and the images are recorded and reported. Compare 20606 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 20606 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
$86.89
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$41.66
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.
Musculoskeletal procedures
About 20606: Intermediate joint aspiration or injection with ultrasound
Reports aspiration, injection, or both for an intermediate joint or bursa when ultrasound guides needle placement and the images are recorded and reported.
This service covers needle aspiration, injection, or both in an intermediate joint or bursa with ultrasound guidance. Typical sites include the wrist, elbow, ankle, acromioclavicular joint, temporomandibular joint, and olecranon bursa. Orthopedic clinicians, rheumatologists, and other qualified practitioners commonly perform it in an office or outpatient setting. The ultrasound guidance, image recording, and reporting are part of the service.
Select the code by the joint or bursa’s size and whether ultrasound guidance is used: this code is for an intermediate site with ultrasound, not a small or major site. The record should identify the treated site, the aspiration or injection performed, and the ultrasound guidance and image documentation. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 identifies a bilateral procedure, which CMS pays at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 20606
- 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 RVU0.98 · 35%
- Practice expense (office) RVU1.72 · 61%
- Malpractice RVU0.12 · 4%
59.4K
Medicare services in 2024 · #719 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.
20606 compared with similar codes
Office rates for Iowa, from the same CMS release.
$80.33
20604 is for a small joint or bursa with ultrasound guidance. 20606 is for an intermediate joint or bursa with ultrasound guidance.
$95.97
20611 applies to a major joint or bursa with ultrasound guidance. Use 20606 for an intermediate site instead.
$62.89
20610 is for a major joint or bursa without ultrasound guidance. 20606 is for an intermediate site and includes ultrasound guidance.
Compare 20606 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
$86.89
Facility
$41.66
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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 20606 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
1,769
- Code
- 20606
- Physician work
- 0.98
- Practice expense
- 1.72
- Malpractice
- 0.12
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.98 | × 1.000 | 0.9800 |
| Practice expense | 1.72 | × 0.915 | 1.5738 |
| Malpractice | 0.12 | × 0.397 | 0.0476 |
| Total RVUs | 2.6014 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$86.89
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.98 | 1 |
| Practice expense | 1.72 | 0.915 |
| Malpractice | 0.12 | 0.397 |
(0.98 × 1 + 1.72 × 0.915 + 0.12 × 0.397) × $33.4009 = $86.89
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.98 | 1 |
| Practice expense | 0.24 | 0.915 |
| Malpractice | 0.12 | 0.397 |
(0.98 × 1 + 0.24 × 0.915 + 0.12 × 0.397) × $33.4009 = $41.66
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.
20606 billing questions
How is 20606 different from 20605?
Both apply to an intermediate joint or bursa, but 20606 includes ultrasound guidance with image recording and reporting. Use 20605 when the intermediate-site procedure is performed without ultrasound guidance.
Which sites are considered intermediate for this code?
Common examples include the wrist, elbow, ankle, acromioclavicular joint, temporomandibular joint, and olecranon bursa. Choose the code based on the treated anatomy and whether ultrasound guidance is used.
Can ultrasound guidance be billed separately?
The ultrasound guidance, image recording, and reporting are included in 20606. Document the guidance and images, but do not separately report ultrasound guidance for this same procedure.
What documentation supports 20606?
Record the specific joint or bursa, whether aspiration, injection, or both were performed, and the use of ultrasound guidance. Retain the required image recording and report.
How is a bilateral procedure reported?
CMS identifies 20606 as bilateral when reported with modifier 50 and pays it at 150%. The medical record should support treatment of the corresponding site on both sides.
What happens when 20606 is performed with another procedure?
For multiple procedures in the same session, CMS pays the highest-valued procedure in full and the other procedures at 50%. Same-day preoperative and postoperative care is included in 20606’s 0-day global period.
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.
1,76620600,,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
1,7702060F,,Pt intrvwd on/before dx mdd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,77120610,,Drain/inj joint/bursa w/o us,A,,0.77,1.16,,0.29,,0.13,2.06,1.19,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,77220611,,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
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