Removal of cervical traction tongs or a halo device that was originally applied by a different provider.

Verified May 8, 2026 · 6 sources ↓

Medicare: $117.91
Work RVU: 1.33
Global, days: 10
Region: Spine

Drawn from CMSAAPCPayerpriceEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the original applying provider by name and the date of device application — this distinguishes 20665 from same-provider removal codes
Document the type of device removed: tongs (U-shaped cervical traction) or halo ring, including brand/model if available
Record neurological status and cervical alignment assessment immediately before and after device removal
Note the clinical indication for removal at this point in the treatment course (goal alignment achieved, care transfer, complication, etc.)
Document place of service accurately — inpatient vs. outpatient affects facility payment rates significantly
If a staged procedure is planned post-removal, note that in the operative or procedure report to support modifier 58 if billed

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 52 Reduced services 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

20665 covers the removal of cervical traction hardware — either tongs (U-shaped) or a halo ring — when the removing clinician is not the one who originally applied the device. That distinction drives the code choice: if the same provider applies and removes the device, a different code applies. The 10-day global period means routine follow-up through day 10 is bundled; anything unrelated in that window needs modifier 24 or 25.

This procedure appears most frequently in inpatient hospital (POS 21) and on-campus outpatient hospital (POS 22) settings. Radiation oncology leads utilization in CMS PUF data — halo use in radiation treatment positioning explains much of that volume. Orthopedic and neurosurgical practices bill it when a patient transfers care mid-traction course and the receiving surgeon completes the removal.

Documentation must establish that the applying provider and the removing provider are distinct — this is the axis on which 20665 turns. Note the date and identity of the original application, the clinical reason for removal, and the patient's neurological status pre- and post-removal. Missing that provider distinction is the primary reason payers downcode or deny this claim.

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 (1.33) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.53) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.33
Practice expense RVU	2.09
Malpractice RVU	0.11
Total RVU	3.53
Medicare national rate	$117.91
Global period	10 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	$117.91
HOPD (APC 5735) Hospital outpatient department	$456.40
ASC (PI G2) Ambulatory surgical center (freestanding)	$241.78

Common denial reasons

The recurring reasons claims for CPT 20665 get rejected.

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

Same-provider removal billed as 20665 — payer flags that the applying and removing provider share the same NPI, requiring a different code
Missing documentation that the device was applied by a different individual — the 'by another individual' requirement is the code's defining element and must be explicit in the note
Global period conflicts — services billed during another surgeon's active global period without modifier 24 or 79
Place of service mismatch between the claim and the facility's billing, triggering medical review or automated denial
Insufficient documentation of device type — operative notes that reference 'cervical traction device removed' without specifying tongs vs. halo create audit exposure

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What makes 20665 the right code instead of a different tongs/halo removal code?

20665 is used specifically when the provider removing the device is not the one who originally applied it. If the same provider both applies and removes the device, a different code in the tongs/halo family applies. The 'by another individual' language is the operative distinction.

02Does the 10-day global period affect what else I can bill on the day of removal?

The global covers the removal and routine follow-up through day 10. A separately identifiable E/M on the same date needs modifier 25. Procedures unrelated to the removal billed within the global window need modifier 79.

03Why does Radiation Oncology top the utilization data for this code?

Radiation oncology teams frequently use halo-type immobilization frames for stereotactic radiosurgery treatment positioning. When the frame is applied by one provider and removed by another — common in multi-disciplinary SRS workflows — 20665 is the correct removal code.

04Can I bill 20665 with modifier 62 if two surgeons co-manage the removal?

True two-surgeon billing with modifier 62 requires that two surgeons with different skills are each performing distinct portions of the procedure simultaneously. Halo or tongs removal rarely meets that threshold. Modifier 80 or AS is more appropriate if an assistant is present.

05What ICD-10 diagnoses typically pair with 20665?

Cervical fracture aftercare codes (Z47.89, Z96.698-range sequelae), cervical instability, and spinal deformity correction statuses are the most common pairings. The diagnosis should reflect the underlying condition that originally required the traction device, not just the removal itself.

06If the patient is transferred from another facility mid-traction course, does 20665 still apply?

Yes. A care transfer is a classic 20665 scenario. Document the transfer, the name of the original applying provider or facility, and the date of original application. That paper trail is what justifies the code and protects against same-provider denial.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the name and specialty of the provider who applied the tongs or halo, the application date, the device type, the clinical rationale for removal, and the patient's neurological status before and after removal — all from your dictation. That prevents the most common denial for 20665: a claim where the record doesn't explicitly establish that a different provider applied the device.

See how Mira captures CPT 20665 documentation