Application of a halo-pelvic fixation device, including subsequent removal — used to apply traction or immobilize the spine via a skull halo, pelvic hoop with pins, and connecting threaded bars.

Verified May 8, 2026 · 5 sources ↓

Medicare: $501.01
Work RVU: 6.22
Global, days: 90
Region: Spine

Drawn from CMSAAPCFindacode

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Diagnosis driving halo-pelvic application (e.g., spondylolisthesis, scoliosis, kyphosis) with supporting imaging
Description of skull halo pin placement sites and pelvic hoop pin placement sites by anatomic location
Documentation of traction force applied or immobilization objective, including any correction measurement if applicable
Operative or procedure note confirming the connecting bar configuration and any intraoperative adjustments
Removal is included — note removal date and clinical status in the same global episode record
Any imaging used during application must be documented; do not bill separately unless a distinct additional procedure was performed

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon 24 Unrelated E/M during global 25 Significant separate E/M

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 20662 covers the application of a halo-pelvic fixation construct and includes its removal. The device couples a skull halo to a pelvic hoop through vertical threaded bars, generating traction force or rigid immobilization. Clinical indications include lumbosacral spondylolisthesis, scoliosis, and tuberculous kyphosis, as well as spinal instability requiring external immobilization.

This code carries a 90-day global period under CMS Physician Fee Schedule 2026. That global window covers the application, all routine post-application management, pin-site checks, adjustments, and the removal. Any E/M service unrelated to the halo-pelvic construct billed during that 90 days requires modifier 24. A new problem requiring a separate decision for surgery requires modifier 25 on the same-day E/M.

Because the procedure involves both skull and pelvic fixation points, operative documentation must precisely describe each anatomic site of pin placement and the traction force or immobilization goal. Imaging used for guidance is bundled per NCCI policy unless a separately identifiable procedure is performed at a distinct anatomic site — do not bill fluoroscopy separately unless it meets that threshold.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (6.22) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.22
Practice expense RVU	7.46
Malpractice RVU	1.32
Total RVU	15
Medicare national rate	$501.01
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$501.01
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI R2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 20662 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing or vague operative note that does not specify pin placement sites for both skull and pelvic components
Separately billed fluoroscopy or imaging bundled into the procedure per NCCI policy
E/M services billed within the 90-day global period without modifier 24 for unrelated conditions
Diagnosis code does not support medical necessity for halo-pelvic traction or immobilization
Billing removal of the device as a separate service when removal is included in 20662

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Is removal of the halo-pelvic device billed separately?

No. Removal is included in 20662. Billing a separate removal code for the same construct applied under this code will be denied as unbundling.

02Can fluoroscopy be billed separately when used during halo-pelvic application?

Generally no. NCCI policy bundles imaging guidance into the procedure when guidance is inherent to the application. Only bill imaging separately if a distinct, additional procedure was performed at a separate anatomic site on the same date.

03What modifier do I use if an E/M is billed on the same day as 20662?

Use modifier 25 on the E/M to indicate it was a separate, significant service beyond the decision to apply the device. Document the distinct clinical problem addressed.

04What modifier applies to E/M visits during the 90-day global for unrelated conditions?

Modifier 24 on the E/M. The diagnosis on that visit must be unrelated to the halo-pelvic fixation or its direct management to support medical necessity.

05Does 20662 apply to a skull halo without the pelvic component?

No. 20662 is specific to halo-pelvic fixation, which requires both the skull halo and the pelvic hoop with connecting bars. A skull halo alone maps to a different code family; verify the correct code based on the construct actually applied.

06Can 20662 be billed with modifier 22 for increased complexity?

Yes, if the application required substantially more work than typical — for example, due to severe deformity, prior hardware complications, or unusually complex pin site management. Document the specific factors that increased intraoperative time and complexity.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the specific diagnosis indication, skull halo pin sites, pelvic hoop pin sites, number and configuration of connecting bars, traction force or immobilization goal, and any intraoperative imaging used — directly from dictation. This prevents the most common audit flag for 20662: operative notes that describe a halo-pelvic construct without documenting both anatomic fixation regions with sufficient specificity.

See how Mira captures CPT 20662 documentation