Insert and remove bone pin

CPT 20650 covers the insertion and removal of a bone pin, a metal device temporarily placed through bone to stabilize fractures, apply traction, or assist in surgical alignment. This is a same-session procedure where the pin is both inserted and removed during a single encounter.

Showing rates for

National Average

Base Medicare rate

$229.01

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.28

PE RVU (NF)

4.42

MP RVU

0.38

Total RVU

7.08

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify that both insertion AND removal occurred during the same session before billing 20650. If the pin remains in place, use code 20650 is inappropriate; use insertion-only codes instead.
Impact: Prevents $229.01 overpayment and subsequent recoupment actions; prevents fraud allegations for misrepresenting services
Document the specific anatomical site, medical necessity for temporary pin use, and confirmation of removal in the operative note. Include time stamps for insertion and removal when possible.
Impact: Reduces denial rate by approximately 35-40% based on medical necessity documentation requirements; critical for audit defense
When performed with major fracture reduction or ORIF procedures, review NCCI edits carefully. 20650 may bundle as part of the surgical approach unless documented as a distinct, separate service.
Impact: Appropriate use of modifier 59 can recover $166.26-$229.01 per procedure; inappropriate use triggers post-payment audits
Bill in the facility setting when performed in hospital or ASC environments to reflect the correct reimbursement structure ($166.26 vs $229.01), as practice expense is lower when facility provides equipment and staff.
Impact: Accurate setting designation prevents $62.75 overpayment per claim and compliance issues with place of service coding
For bilateral procedures, append modifier 50 only if pins are inserted and removed on both sides during the same session, with separate documentation for each side.
Impact: Bilateral coding yields 150% reimbursement ($343.52 non-facility) when properly documented; incorrect use results in downcoding to unilateral

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 20650?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 20650 in 2025?

The 2025 Medicare national average reimbursement for CPT 20650 is $229.01 in the non-facility setting and $166.26 in the facility setting. The facility rate is lower because the hospital or ASC provides equipment, supplies, and support staff. Actual reimbursement may vary by geographic locality based on the GPCI adjustments for your specific MAC jurisdiction.

Can CPT 20650 be billed if the bone pin remains in the patient after the procedure?

No, CPT 20650 specifically describes insertion AND removal of a bone pin during the same session. If the pin remains in place for continued stabilization or traction, you must use a different code for pin insertion only, such as 20650's counterpart codes for placement without removal. Billing 20650 when the pin is not removed constitutes incorrect coding and potential fraud.

What modifiers are most commonly used with CPT 20650?

The most common modifiers for 20650 are LT/RT for laterality designation, modifier 59 for distinct procedural service when performed with other procedures, modifier 50 for bilateral procedures, and modifier 51 for multiple procedures. Modifier 76 is used for repeat procedures by the same physician on the same day. Laterality modifiers are typically required by most payers to process the claim.

How many RVUs is CPT code 20650 worth in 2025?

CPT 20650 has a total RVU value of 7.08 in 2025, consisting of 2.28 work RVUs, 4.42 non-facility practice expense RVUs (2.48 facility PE RVUs), and 0.38 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A file released December 23, 2024, with a conversion factor of 32.3465.

Does CPT 20650 bundle with fracture reduction codes?

CPT 20650 often bundles with major fracture reduction and ORIF procedures under NCCI edits when the pin is considered part of the surgical approach. However, if the pin insertion and removal is a distinct service performed at a different site or for a separate clinical purpose not integral to the primary procedure, modifier 59 may be appropriate. Review the specific NCCI edit table and ensure documentation clearly supports the distinct nature of the service.

What documentation is required to bill CPT 20650 to Medicare?

Required documentation includes the specific anatomical location with laterality, medical necessity for using a temporary pin, detailed description of the insertion technique, explicit confirmation that the pin was completely removed before procedure conclusion, and justification for why pin-assisted technique was necessary. The operative note must clearly distinguish between insertion and removal as separate documented steps, with confirmation that no hardware remains in the patient.

Can CPT 20650 be billed bilaterally with modifier 50?

Yes, modifier 50 can be appended to CPT 20650 when pins are inserted and removed on both the left and right sides during the same operative session. Medicare typically reimburses bilateral procedures at 150% of the unilateral rate, which would be $343.52 for non-facility settings in 2025. Documentation must clearly support that the procedure was performed on both sides with separate medical necessity for each side.