Apply rem fixation device

CPT code 20660 covers the application of an external fixation device, a metal frame attached to bones through the skin with pins or wires to stabilize fractures or correct deformities. This is different from initial placement and represents removal and reapplication or adjustment of existing hardware.

Showing rates for

National Average

Base Medicare rate

$235.16

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

PE RVU (NF)

1.97

MP RVU

1.3

Total RVU

7.27

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

NCCI bundling edits

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Billing tips

Clearly document that this is removal AND reapplication, not initial application (20690/20692) or removal only (20670/20680)
Impact: Prevents denials for incorrect code selection; initial application codes reimburse at different rates and have different global periods
Document the specific reason for reapplication (alignment issue, pin loosening, frame modification, staged correction) separate from routine adjustments
Impact: Justifies medical necessity and prevents denial as included in global surgical package of initial application; can mean difference between $235.16 payment and $0
Bill with appropriate modifier 58 or 79 if performed during global period of initial fixator placement to bypass global surgery edit
Impact: Without proper modifier, claim will deny as included in global period; proper modifier use secures full $235.16 reimbursement
Do not bill 20660 on the same date as initial fracture treatment or fixator application codes unless distinct anatomic sites
Impact: CCI edits bundle 20660 with many fracture care codes; inappropriate unbundling triggers audits and potential recoupment plus penalties
Verify that facility vs non-facility designation is correctly reported; both reimburse identically at $235.16 for this code
Impact: Unusual for surgical codes to have identical rates; reduces common place-of-service claim errors but documentation must still support setting
Document time spent and complexity if performed with other procedures; consider whether E/M service with modifier 25 is separately reportable
Significant separate E/M may add $75-150+ to total reimbursement if properly documented and not included in surgical decision-making

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 20660 in 2025?

The 2025 Medicare national average reimbursement for CPT 20660 is $235.16 for both facility and non-facility settings, based on 7.27 total RVUs and the conversion factor of 32.3465.

What is the difference between CPT 20660 and 20690?

CPT 20660 is for removal and reapplication of an existing external fixation device, while 20690 is for initial application of a uniplane external fixation system. Code 20660 is used when a previously placed fixator needs to be taken down and replaced, not for the first-time application.

Can CPT 20660 be billed during the global period of the initial fixator placement?

Yes, but it requires modifier 78 (unplanned return to OR for complication) or modifier 58 (staged/planned procedure) to bypass the global surgery edit. Without the appropriate modifier, the claim will deny as included in the global period. Modifier 78 reduces payment while 58 allows full reimbursement if properly documented as planned.

How many RVUs is CPT code 20660 worth?

CPT 20660 has 7.27 total RVUs in 2025, consisting of 4.0 work RVUs, 1.97 practice expense RVUs (both facility and non-facility), and 1.3 malpractice RVUs.

What modifiers are commonly used with CPT 20660?

Common modifiers include RT/LT for laterality, modifier 58 for staged/planned reapplication, modifier 79 for unrelated procedure during postop period, and modifier 78 for unplanned return to OR for complications. Laterality modifiers are required for proper claim processing.

Does CPT 20660 include removal only of an external fixator?

No, CPT 20660 specifically describes removal AND reapplication. For removal only, use CPT 20670 (removal of superficial implant) or 20680 (removal of deep implant). The reapplication component is what distinguishes 20660 from simple removal codes.

What documentation is needed to bill CPT 20660 without denial?

Required documentation includes clear description of removing the existing fixator, clinical justification for reapplication (not just adjustment), details of the new configuration applied, pre- and post-procedure alignment assessment, and explicit statement that this is reapplication not initial placement. Medical necessity must be established separate from routine care included in the global period.