Rmvl ext fixj sys under anes

CPT code 20694 covers the removal of an external fixation device (a metal frame attached to bone with pins or wires to stabilize fractures) when the patient requires anesthesia for the procedure.

Showing rates for

National Average

Base Medicare rate

$425.68

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

4.28

PE RVU (NF)

8.09

MP RVU

0.79

Total RVU

13.16

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

NCCI bundling edits

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Billing tips

Clearly document why anesthesia was medically necessary rather than simple local anesthesia, including factors like fixator complexity, number of pins/wires, or patient-specific considerations
Impact: Prevents downcoding to simpler removal codes (20670, 20680) which reimburse $84-170 less than 20694's $425.68
Bill facility versus non-facility location correctly based on site of service; use POS code 22 for outpatient hospital, 24 for ASC
Impact: Ensures correct rate application: $425.68 non-facility vs $341.26 facility, avoiding $84.42 underpayment or overpayment recoupment
When multiple fixation systems are removed from different anatomic sites, append modifier 59 to the second code and document distinct sites clearly
Impact: Secures additional $425.68 payment for legitimately separate procedures that might otherwise be bundled
Verify the original fixation placement is outside the 90-day global period before billing 20694 separately; if within global, use modifier 79 only if truly unrelated
Impact: Prevents denials for services included in global surgical package, preserving the full $425.68 reimbursement
Report anesthesia separately using appropriate anesthesia CPT codes (01382 for lower leg, 01480 for shoulder) when applicable
Impact: Captures additional $200-400 in anesthesia reimbursement beyond the surgical payment
Link appropriate ICD-10 codes indicating healed fracture (Z47.89) or complication requiring removal rather than just the original fracture diagnosis
Impact: Demonstrates medical necessity for the removal procedure, reducing denial rates by 25-40%

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Frequently asked questions

What is the Medicare reimbursement for CPT 20694 in 2025?

Medicare pays $425.68 for CPT 20694 in non-facility settings and $341.26 in facility settings under the 2025 Physician Fee Schedule. The difference of $84.42 reflects overhead costs absorbed by hospitals and ASCs versus physician offices.

What is the difference between CPT 20694 and 20670?

CPT 20694 is specifically for removal of an external fixation system under anesthesia, while 20670 covers removal of superficial implants not requiring anesthesia. Code 20694 has significantly higher reimbursement ($425.68 vs approximately $150) due to the complexity and anesthesia requirement.

Can CPT 20694 be billed during the global period of the original fracture repair?

Generally no, unless the removal is unrelated to the original procedure (modifier 79) or due to complications requiring return to the operating room (modifier 78). Most external fixation removals after normal healing are included in the 90-day global period and cannot be separately billed.

How many RVUs is CPT code 20694 worth?

CPT 20694 has a total of 13.16 RVUs: 4.28 work RVUs, 8.09 non-facility practice expense RVUs (5.48 facility), and 0.79 malpractice RVUs based on the 2025 Medicare Physician Fee Schedule.

What documentation is required to bill CPT 20694?

Documentation must include the type and complexity of the external fixation system, number of pins/wires removed, medical necessity for anesthesia, type of anesthesia administered, radiographic evidence of healing, and the specific anatomic location. Anesthesia records must corroborate the operative report.

Can you bill CPT 20694 bilaterally with modifier 50?

Yes, if external fixation systems are removed from both sides during the same operative session, modifier 50 is appropriate and typically results in 150% reimbursement (approximately $638.52 for Medicare non-facility). Documentation must clearly support bilateral procedures.

What ICD-10 codes are typically used with CPT 20694?

Z47.89 (encounter for other orthopedic aftercare) is the primary code for routine fixation removal after healing. Alternative codes include T84.60XA for mechanical complication of internal fixation device, or specific healed fracture codes with 7th character D (subsequent encounter) depending on the clinical scenario.