No office rate
Use 20690 for initial application of a uniplane external fixation system. Use 20693 for adjustment or revision of an existing system requiring anesthesia.
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CMS RVU26D · Effective 2026-10-01
20693 Fixator adjustment Medicare reimbursement rates in Vermont
Report this service when a surgeon adjusts or revises an existing external fixation system and the work requires anesthesia, rather than initial device placement or removal. Compare 20693 office and facility rates across CMS payment localities in Vermont.
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 20693 in Vermont?
Vermont 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
$410.57
1 of 1 localities have a supported rate.
Payment area: Vermont
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 20693: External fixation system adjustment under anesthesia
Report this service when a surgeon adjusts or revises an existing external fixation system and the work requires anesthesia, rather than initial device placement or removal.
An orthopedic surgeon reports this service for adjustment or revision of an external fixation system when anesthesia is required. The work may address fracture alignment or correct a deformity using an existing frame. It is distinct from applying a new external fixator or removing the system. These procedures are commonly performed in an operating room or another setting equipped to provide anesthesia and manage the fixation device.
Select the code based on the documented adjustment or revision and the need for anesthesia. The operative record should identify the existing fixation system, the change made, the clinical purpose, and the anesthesia requirement. CMS assigns a 90-day global period, including 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 multiple-procedure 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 20693
- 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 RVU5.91 · 46%
- Practice expense (office) RVU5.91 · 46%
- Malpractice RVU1.05 · 8%
476
Medicare services in 2024 · #3607 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.
20693 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
Use 20692 for initial application of a multiplane external fixation system. It does not describe adjustment or revision of an existing system.
$445.94
Use 20694 when the external fixation system is removed under anesthesia. Use 20693 when the service adjusts or revises the system instead.
No office rate
20696 describes initial application of a multiplane system with stereotactic computer-assisted adjustment; 20693 describes adjustment or revision of an existing system requiring anesthesia.
Compare 20693 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
Vermont →
Office / nonfacility
Unavailable
Facility
$410.57
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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 20693 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
1,786
- Code
- 20693
- Physician work
- 5.91
- Practice expense
- 5.91
- Malpractice
- 1.05
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.91 | × 1.000 | 5.9100 |
| Practice expense | 5.91 | × 0.990 | 5.8509 |
| Malpractice | 1.05 | × 0.506 | 0.5313 |
| Total RVUs | 12.2922 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$410.57
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.91 | 1 |
| Practice expense | 5.91 | 0.99 |
| Malpractice | 1.05 | 0.506 |
(5.91 × 1 + 5.91 × 0.99 + 1.05 × 0.506) × $33.4009 = $410.57
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.
20693 billing questions
How does this differ from applying an external fixator?
This code is for adjustment or revision of an existing system requiring anesthesia. Codes 20690 and 20692 describe initial application of specified external fixation systems.
Can this code be used for removal of the frame?
No. Removal of an external fixation system under anesthesia is described by 20694. Report 20693 when the service is an adjustment or revision.
What documentation supports reporting 20693?
Document the existing external fixation system, the adjustment or revision performed, its clinical purpose, and that the service required anesthesia.
Can modifier 50 be reported for adjustment on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor, so modifier 50 should not be used.
How does the 90-day global period affect postoperative care?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. The service is treated as major surgery for this purpose.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted under the CMS rules provided.
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.
1,78320680,,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
1,78820696,,App mltpln uni xtrnl fix 1st,A,,17.12,11.66,NA,11.66,,3.01,31.79,31.79,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,78920697,,App mltpln uni xtrnl fix xch,A,,0.00,57.17,,57.17,NA,0.03,57.20,57.20,3,000,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817