No office rate
20660 describes application of cranial tongs or another skeletal fixation device and includes removal. Report 20665 when the removal is a separate service.
On this page
CMS RVU26D · Effective 2026-10-01
20665 Cranial device removal Medicare reimbursement rates in Missouri
Removal of cranial traction tongs or a halo apparatus after treatment, reported when the device is removed as a separate service. Compare 20665 office and facility rates across CMS payment localities in Missouri.
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 20665 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
$108.18–$114.56
3 of 3 localities have a supported rate.
Facility setting
$80.54–$84.04
3 of 3 localities have a supported rate.
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.
Where 20665 pays more and less in Missouri
3 payment localities
$108.18 to $114.56
Orthopedic procedure
About 20665: Removal of cranial tongs or halo
Removal of cranial traction tongs or a halo apparatus after treatment, reported when the device is removed as a separate service.
This service removes cranial traction tongs or a halo apparatus used to stabilize the head and cervical spine. It is typically performed by an orthopedic spine surgeon or neurosurgeon when the period of skeletal traction or halo immobilization is complete. Removal may take place in a facility or another setting equipped to manage the patient and device.
Report the removal service when tongs or a cranial halo are taken off separately, rather than as part of an application service that includes removal. The record should identify the device removed and document the removal performed. The code has a 10-day global period, so related postoperative visits during that period are included. 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% multiple-procedure 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 20665
- 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
- 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 RVU1.33 · 38%
- Practice expense (office) RVU2.09 · 59%
- Malpractice RVU0.11 · 3%
789
Medicare services in 2024 · #3160 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.
20665 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
20661 describes cranial halo application, including removal. Use 20665 for removal performed separately from application.
$328.37–$355.89
20670 is for removal of a superficial orthopedic implant. 20665 is specific to cranial tongs or a halo.
$420.36–$447.77
20694 describes removal of an external fixation system under anesthesia. 20665 is for cranial tongs or a halo.
Compare 20665 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
$113.56
Facility
$83.45
Metropolitan St. Louis →
Office / nonfacility
$114.56
Facility
$84.04
Rest Of Missouri →
Office / nonfacility
$108.18
Facility
$80.54
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20665 billing questions
When should 20665 be reported instead of a halo application code?
Use 20665 when cranial tongs or a halo are removed as a separate service. Application codes that include removal describe a different service when the device is applied.
Does 20665 include related follow-up visits?
Yes. The 10-day global period includes related postoperative visits during those 10 days.
Can modifier 50 be reported for removal on both sides?
No. Modifier 50 is inappropriate for this code.
How is 20665 affected when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is available 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.
1,77820662,,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
1,77920663,,Application halo femoral,A,,5.60,7.11,NA,7.11,,1.21,13.92,13.92,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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