Removal of an external fixation system performed under anesthesia, reported when the complexity of fixator removal requires an anesthetic beyond local infiltration.

Verified May 8, 2026 · 8 sources ↓

Medicare: $461.93
Total RVUs: 13.83
Global, days: 90
Region: General

Drawn from CMSAAPCMdclarityFindacodeEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify the type of anesthesia administered — general, regional, or MAC — confirming it was required for the removal
Document the external fixation system removed, including pin or frame configuration and anatomic site
Note the clinical reason anesthesia was necessary (e.g., patient age, complexity, pain tolerance, soft tissue involvement)
If billing during a global period, document whether this removal was planned (staged) or unplanned, and its relationship to the original procedure
Record the original procedure and date the external fixator was applied to establish timeline for global period analysis
Operative note must distinguish removal of the external fixator from any concurrent internal fixation or ORIF performed the same day

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 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

20694 covers the removal of an external fixation system when anesthesia is required to complete the procedure. The anesthesia requirement is the critical billing distinction: removal without anesthesia is not separately reportable because local infiltration is considered inclusive to the original fixation codes. If your surgeon removes the external fixator under general, regional, or monitored anesthesia care, 20694 is the correct code. Removal done in the office or clinic without anesthesia does not qualify.

This code carries a 90-day global period. When the fixator was placed during a procedure still within its own global window, expect scrutiny — Medicare has denied 20694 billed during the global of a prior procedure. If the removal is a planned staged procedure, modifier 58 applies. If the patient returns unplanned for a related complication requiring fixator removal, use modifier 78. If the removal is unrelated to the original procedure, use modifier 79.

Same-day billing with ORIF codes has generally survived NCCI editing — 20694 and ORIF codes are not currently bundled. However, 20694 and excisional debridement (e.g., 11043) are bundled under NCCI, with debridement considered a component. If your surgeon also adjusts the fixator (20693) and then removes it in the same session, NCCI edits apply; modifier 59 or XS may be needed, but confirm the edit type before appending.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.17
Practice expense RVU	8.87
Malpractice RVU	0.79
Total RVU	13.83
Medicare national rate	$461.93
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	$461.93
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 20694 get rejected.

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

Billed during the global period of the original fixation procedure without the correct modifier (58, 78, or 79)
Anesthesia requirement not documented — payer treats removal as a non-separately-reportable inclusive service
NCCI bundle conflict when billed same-day with excisional debridement codes such as 11043
Modifier 78 and 79 confused or omitted when billing during a postoperative period — use 78 for related unplanned return, 79 for unrelated
Claim submitted without linking the correct ICD-10 diagnosis code reflecting the healed or stable fracture status prompting fixator removal

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can 20694 be billed if the external fixator is removed in the office without anesthesia?

No. Removal without anesthesia is not separately reportable. Local infiltration is included in the original fixation codes. 20694 applies only when general, regional, or monitored anesthesia is required and administered.

02Is 20694 bundled with ORIF codes under NCCI?

Based on current NCCI edits, 20694 and ORIF codes are not bundled and can be reported together on the same date. Run the specific code pair through an NCCI tool before billing to confirm no edit has been added.

03What modifier do I use when the fixator removal happens during the global period of the original procedure?

Use modifier 58 if the removal was a planned staged procedure. Use modifier 78 if the patient returned unplanned for a related reason. Use modifier 79 if the removal is unrelated to the original procedure. Do not leave the global-period claim unmodified — it will deny.

04Can 20694 and 20693 (adjustment of external fixator) be billed together on the same day?

NCCI edits exist between these codes. If the surgeon adjusts and then removes the fixator in the same session, review the edit type. A modifier such as 59 or XS may allow separate reporting if distinct services are documented, but the edit must be bypassed correctly.

05Why is 20694 denied when billed with 11043 excisional debridement?

NCCI considers debridement a component of the fixator removal when performed at the same site in the same session. The debridement is bundled into 20694 and is not separately reportable under this pairing.

06What is the global period for 20694, and what does it cover?

20694 carries a 90-day global period. That includes the day of surgery and all routine postoperative care through day 90. Unrelated E/M visits or new procedures in that window require modifier 24, 25, or 79 as appropriate.

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 anesthesia type, external fixator configuration, anatomic site, and the surgeon's stated rationale for why anesthesia was required. It also flags the date the fixator was originally applied so the coder can determine whether the claim falls inside a global period and which modifier — 58, 78, or 79 — applies. This prevents the most common denial: removal billed into a global window with no modifier and no documented staged-procedure intent.

See how Mira captures CPT 20694 documentation