CPT 20650
Global 010 ActiveInsert and remove bone pin
CPT 20650 Billing & Documentation Guide
CPT code 20650 (Insert and remove bone pin) is classified under Surgery (Musculoskeletal) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.22, a non-facility practice expense RVU of 4.87, and a malpractice RVU of 0.38, a total non-facility RVU of 7.47 and facility RVU of 4.79. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $256.29, though rates vary from $220.41 to $323.67 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 20650, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 20650 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 4 units of 20650 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 20650
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.22 | 2.22 |
| Practice Expense RVU | 4.87 | 2.19 |
| Malpractice RVU | 0.38 | 0.38 |
| Total RVU | 7.47 | 4.79 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 20650
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $276.16 | $170.24 | $260.49 - $323.67 | 29 |
| Florida | $262.06 | $172.25 | $248.73 - $275.58 | 3 |
| Georgia | $244.63 | $159.23 | $234.37 - $254.88 | 2 |
| Illinois | $255.83 | $169.34 | $242.5 - $267.27 | 4 |
| Michigan | $244.76 | $160.7 | $236.99 - $252.52 | 2 |
| North Carolina | $234.02 | $150.51 | $234.02 - $234.02 | 1 |
| New York | $276.39 | $176.52 | $237.6 - $295.87 | 5 |
| Ohio | $235.45 | $153.73 | $235.45 - $235.45 | 1 |
| Pennsylvania | $247.71 | $160.03 | $235.47 - $259.96 | 2 |
| Texas | $246.49 | $158.36 | $233.96 - $257.64 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 20650
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 20650 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 11000 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 20650
What does CPT code 20650 mean? +
CPT code 20650 represents: Insert and remove bone pin. It's in the Surgery (Musculoskeletal) category with a global period of 010.
What is the Medicare reimbursement for CPT 20650? +
The 2026 Medicare national average non-facility payment for CPT 20650 is $256.29. Rates range from $220.41 to $323.67 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 20650? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 20650? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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