Removal of a superficial implant such as a buried wire, pin, or rod through a small incision without layered closure

Verified May 8, 2026 · 5 sources ↓

Medicare: $370.42
Total RVUs: 11.09
Global, days: 10
Region: General

Drawn from AAPCCMSCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific implant removed: type (wire, pin, rod), location, and original fixation procedure
Document that no layered closure was performed — sutures and/or steri-strips only
Confirm the implant was superficial and did not require deep dissection or fascial release
Note the anatomic site explicitly; if billing multiple units, document distinct and separate anatomic sites for each
State the clinical reason for removal (e.g., hardware prominence, pain, migration, planned removal after healing)
If billing same-day with another procedure, document that 20670 was performed at a separate anatomic site or separate encounter

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 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 20670 covers surgical removal of a superficial internal fixation device — typically a buried wire, pin, or rod — where the physician makes a small incision, pulls or unscrews the hardware out, and closes with sutures or steri-strips. No layered closure is involved. This distinguishes it from 20680, which requires a deeper dissection and is almost always performed in an ASC or facility setting. 20670 is routinely performed in the office or clinic.

This is a designated separate procedure. If the hardware removal is a necessary component of another procedure at the same anatomic site — for example, removing a pin as part of a fracture revision for nonunion — 20670 is not separately reportable. NCCI policy is explicit: one unit of service covers all hardware removed from a single anatomic site, regardless of how many screws, wires, or pins come out or how many incisions are used. A second unit is only payable when hardware is removed from a distinct, separate anatomic site.

20670 carries a 10-day global period. Specialties billing this code most frequently include orthopedic surgery, podiatry, and hand surgery. Do not report 20670 for removal of wire sutures during sternal or cardiac reoperation procedures — NCCI explicitly excludes that scenario.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.75
Practice expense RVU	9.07
Malpractice RVU	0.27
Total RVU	11.09
Medicare national rate	$370.42
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	$370.42
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI A2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 20670 get rejected.

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

Bundled into a same-day procedure at the same anatomic site — NCCI treats removal as integral to the primary procedure
Billed as multiple units for hardware removed from one anatomic site — CMS allows only one unit per site regardless of implant count
Upcoded to 20680 or downcoded from 20680: payers audit the operative note for layered closure and depth of dissection
Missing documentation of the specific hardware type and anatomic location, triggering medical necessity denials
Reported during a global period of the original fixation surgery without appropriate modifier when the removal is related

Frequently asked questions

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

01What separates 20670 from 20680?

Depth of dissection and closure. 20670 involves a small incision, the implant is pulled or unscrewed out, and the wound is closed without layered closure. 20680 requires deeper work — fascial or muscle layer dissection — and almost always happens in an ASC or facility, not the office.

02Can I bill 20670 when I remove multiple screws from the same site?

No. CMS allows one unit of service for all hardware removed from a single anatomic site, regardless of how many pieces come out or how many incisions are made. Bill a second unit only when a completely separate anatomic site is involved.

03Is 20670 billable when hardware removal is part of a fracture revision for nonunion?

No. NCCI is explicit: if removal is a necessary integral component of another procedure — like revising a nonunion that requires taking out the original pin — 20670 is not separately reportable.

04What modifier applies if I remove hardware during the global period of the original fixation surgery?

If the removal is unplanned and related to the original procedure, use modifier 78. If it is a planned, staged removal that is unrelated to a complication, modifier 79 applies. Don't use 78 and 79 interchangeably — the distinction is planned vs. unplanned and related vs. unrelated.

05Can 20670 be billed in the office?

Yes. Superficial implant removal is routinely performed in the physician office. 20680 (deep removal) is generally an ASC or facility procedure. Site of service affects your payment rate — see the Site of Service comparison on this page.

06Does 20670 apply to wire suture removal during a sternal reoperation?

No. NCCI explicitly prohibits reporting 20670 or 20680 for wire suture removal during cardiac reoperation or sternal procedures such as debridement, resection, or closure of median sternotomy separation.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the implant type (wire, pin, or rod), exact anatomic site, depth of removal, closure method (sutures vs. steri-strips, no layered closure), and the clinical indication for removal from the surgeon's dictation. This prevents the two most common audit flags: missing hardware specificity and insufficient documentation to justify 20670 over 20680 — or to support a separate-procedure billing when another code is billed same-day.

See how Mira captures CPT 20670 documentation