Rmvl tongs/halo anthr indiv

CPT code 20665 covers the removal of traction tongs or a halo device from a patient's skull when performed by a provider other than the one who originally placed it. This procedure is used to remove orthopedic devices used to stabilize severe neck or spinal injuries.

Showing rates for

National Average

Base Medicare rate

$116.77

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

1.36

PE RVU (NF)

2.13

MP RVU

0.12

Total RVU

3.61

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

NCCI bundling edits

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Billing tips

Document clearly that the removing provider is different from the applying provider, as this is the defining characteristic distinguishing 20665 from 20664
Impact: Prevents automatic denials and downcoding to 20664, protecting the full $116.77 non-facility reimbursement
Verify the global period and ensure the removal is not being performed during the post-operative period of the original application by the same practice
Impact: Avoids bundling denials; if within global period of same group, may result in $0 payment
Bill in the facility setting when performed in hospital or ASC to maximize efficiency, as the facility differential is $19.41 less per case
Impact: Facility receives separate facility fee; provider receives $97.36 versus $116.77 non-facility
Document any complications during removal such as difficult extraction, infection at pin sites, or need for additional anesthesia
Impact: Supports medical necessity and may justify additional E/M codes with modifier 25 if significant separately identifiable service performed
Submit operative report or detailed procedure note with initial claim for commercial payers unfamiliar with this code
Impact: Reduces likelihood of information requests and speeds payment by 15-30 days on average
Check for state-specific workers' compensation fee schedules as rates often exceed Medicare by 20-40% for orthopedic procedures
Impact: Potential reimbursement of $140-$163 versus $116.77 Medicare rate in workers' comp cases

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Frequently asked questions

What is the difference between CPT 20665 and 20664?

CPT 20664 is used when the same provider who applied the tongs or halo removes the device, while 20665 is specifically for removal by a different provider. This distinction is critical for proper billing, as using the wrong code will result in incorrect reimbursement or denials.

How much does Medicare pay for CPT 20665 in 2025?

Medicare pays $116.77 for CPT 20665 in the non-facility setting and $97.36 in the facility setting based on the 2025 national average rates. Actual payment may vary by geographic location due to locality-based adjustments.

Can CPT 20665 be billed with an E/M code on the same day?

Yes, an E/M code can be billed with CPT 20665 using modifier 25 if a significant, separately identifiable evaluation and management service is performed and documented beyond the typical pre- and post-procedure work included in the surgical code.

What are the RVU values for CPT code 20665?

CPT 20665 has a work RVU of 1.36, non-facility practice expense RVU of 2.13, facility practice expense RVU of 1.53, and malpractice RVU of 0.12, for a total non-facility RVU of 3.61 in 2025.

Does CPT 20665 have a global period?

CPT 20665 has a 10-day global period, meaning routine post-operative care for 10 days following the procedure is included in the reimbursement and should not be billed separately unless complications arise requiring significant additional services.

When should I use modifier 54 with CPT 20665?

Modifier 54 should be used with CPT 20665 when the surgeon performs only the removal procedure itself without providing the pre-operative or post-operative management, typically in scenarios where another physician will handle follow-up care. This reduces reimbursement to approximately 70% of the global fee.

Is prior authorization required for CPT 20665?

Prior authorization requirements vary by payer. Medicare typically does not require prior authorization for 20665, but many commercial payers and managed care plans do require it for orthopedic surgical procedures. Always verify with the specific payer before performing the procedure to avoid denial.