No office rate
Choose 20690 for a single-plane external frame and 20692 for a frame with pins or wires in more than one plane.
On this page
CMS RVU26D · Effective 2026-10-01
20690 External fixation Medicare reimbursement rates in Iowa
Report 20690 when an orthopedic surgeon applies a unilateral external fixation frame with pins or wires arranged in a single plane to stabilize bone. Compare 20690 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 20690 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
No supported rate
Facility setting
$493.75
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.
Orthopedic surgery
About 20690: Uniplanar external fixation application
Report 20690 when an orthopedic surgeon applies a unilateral external fixation frame with pins or wires arranged in a single plane to stabilize bone.
An orthopedic surgeon applies a unilateral external frame, anchoring it to bone with pins or wires arranged in one plane. The frame can stabilize a fracture or an osteotomy while the bone heals. This service is typically performed in an operating room or another surgical setting; the defining feature is the single-plane fixation configuration, not the number of pins or wires.
Choose this code when the operative record supports application of a single-plane frame, rather than a multiplanar construct. Document the treated side and bone, the indication, and the frame configuration. The 90-day global period includes the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 20690
- 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
- 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 RVU8.56 · 52%
- Practice expense (office) RVU6.05 · 37%
- Malpractice RVU1.73 · 11%
3.2K
Medicare services in 2024 · #2131 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.
20690 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
20696 describes a multiplanar external fixation system with stereotactic computer-assisted adjustments; 20690 is for single-plane fixation without that feature.
$228.02
20650 covers insertion or removal of a bone pin or wire. It does not describe application of the unilateral external fixation system reported with 20690.
Compare 20690 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
Unavailable
Facility
$493.75
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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 20690 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
1,784
- Code
- 20690
- Physician work
- 8.56
- Practice expense
- 6.05
- Malpractice
- 1.73
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.56 | × 1.000 | 8.5600 |
| Practice expense | 6.05 | × 0.915 | 5.5358 |
| Malpractice | 1.73 | × 0.397 | 0.6868 |
| Total RVUs | 14.7826 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$493.75
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.56 | 1 |
| Practice expense | 6.05 | 0.915 |
| Malpractice | 1.73 | 0.397 |
(8.56 × 1 + 6.05 × 0.915 + 1.73 × 0.397) × $33.4009 = $493.75
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.
20690 billing questions
How does 20690 differ from 20692?
20690 is for a unilateral external frame with pins or wires in one plane. Use 20692 when the fixation is arranged in more than one plane.
Is 20690 reported per pin or wire?
No. Select the code based on the external fixation system's configuration, not the number of pins or wires. Document the frame arrangement in the operative report.
Can modifier 50 be used when both sides are treated?
No. CMS identifies bilateral adjustment as inappropriate for 20690. The descriptor and anatomy do not support modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. The application and this related care are part of the surgical episode.
Can an assistant or co-surgeon be paid for 20690?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
How is 20690 paid when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
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.
1,78120665,,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
1,78720694,,Rmvl ext fixj sys under anes,A,,4.17,8.87,,4.87,,0.79,13.83,9.83,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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