Surgical removal of a deeply embedded fixation implant — such as a buried screw, plate, rod, nail, wire, or metal band — requiring a deep incision typically below the muscle layer.

Verified May 8, 2026 · 5 sources ↓

Medicare: $631.95
Total RVUs: 18.92
Global, days: 90
Region: General

Drawn from CMSAAPCKzanow

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm the implant required a deep incision below the muscle layer — document depth of dissection explicitly
Identify the specific device removed (e.g., 4.5mm cortical screw, DCP plate, IM nail) and the anatomic site
Document the number of incisions made and confirm they all served a single fracture site or anatomic region
State that hardware removal was not an integral component of any simultaneously performed primary procedure
Record the original implantation date or reference the prior surgical note to establish the device history
Layered closure technique should be documented to support the depth classification as 'deep'

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 20680 covers the open surgical removal of a deep internal fixation device previously placed to stabilize a fracture or joint. 'Deep' means the surgeon must incise below the muscle layer to access and extract the hardware — that's the clinical threshold that separates 20680 from 20670, which covers superficial removals. Devices that qualify include buried screws, plates, intramedullary rods, nails, metal bands, and wires requiring deep dissection.

One unit of 20680 covers all hardware removed from a single anatomic site, even if multiple stab incisions were necessary. CMS is explicit: one unit = all screws, rods, and plates removed from one anatomic area, whether through one incision or several. An IM rod with locking screws at both ends is still one unit. A second unit is only reportable when hardware is removed from a distinct second anatomic site.

20680 carries a 90-day global period. If hardware removal is an integral step within a larger procedure — revision ORIF for nonunion, for example — it's not separately billable. The NCCI manual is unambiguous: 20680 cannot be stacked on top of a procedure it's necessary to complete.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.81
Practice expense RVU	12.05
Malpractice RVU	1.06
Total RVU	18.92
Medicare national rate	$631.95
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	$631.95
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 20680 get rejected.

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

Bundled into a same-session primary procedure (e.g., revision ORIF, arthroplasty) where removal is considered integral
Billed as multiple units for a single anatomic site — CMS allows one unit per site regardless of incision count
Coded as 20680 when operative note describes only a superficial incision — payer downcodes to 20670
No documentation distinguishing the removal from the global period of the original fixation surgery
Missing implant identification — audit flags when operative note says 'hardware removed' without specifying device type and site

Frequently asked questions

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

01What makes a removal 'deep' enough for 20680 vs. 20670?

The incision must go below the muscle layer to access the implant. If the hardware sits superficially — accessible without deep muscular dissection — 20670 is correct. The operative note must document the depth of dissection, not just name the device removed.

02Can I bill 20680 multiple times when an IM rod requires locking-screw incisions at both ends?

No. An IM rod with proximal and distal locking screws is a single implant system for a single fracture site. Bill one unit of 20680 regardless of how many stab incisions were required. CMS policy is explicit on this point.

03If hardware removal is performed at two separate anatomic sites in the same session, can I bill two units?

Yes. CMS allows a second unit when hardware is removed from a distinct second anatomic site in the same operative session. Use modifier 59 to distinguish the two sites and document each site separately in the operative note.

04Can 20680 be billed during the global period of the original fracture repair?

It depends on timing and context. If the removal is a planned staged procedure (modifier 58) or an unrelated procedure (modifier 79), it can be billed during the original global period. If the removal is an unplanned return for a related complication, use modifier 78. Never bill 20680 as a separate service when it's an integral step of a simultaneously performed revision procedure.

05What modifier applies if hardware removal is attempted but the surgeon cannot complete it?

Append modifier 52 (reduced services) to 20680. This signals the procedure was attempted but not fully accomplished. Document the attempts and the reason for failure in the operative note.

06Is 20680 separately reportable when performed as part of a same-session arthroplasty or revision ORIF?

No, if the removal is a necessary step to complete the primary procedure. The NCCI manual states that 20680 is not separately reportable when it's integral to another procedure performed at the same site. If the hardware removal required meaningfully separate work at a distinct site, modifier 59 and strong documentation are required.

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 and name, the anatomic site, incision depth relative to the muscle layer, and whether hardware removal was the primary purpose of the encounter or subordinate to another procedure. This prevents the two most common 20680 denials: depth miscoding (20680 vs. 20670) and improper bundling with a simultaneously performed revision procedure. The scribe also flags when multiple incisions serve a single fracture site, prompting the coder to bill one unit rather than multiple.

See how Mira captures CPT 20680 documentation