20697

Removal and replacement of a single strut in a multiplane unilateral external fixation system that uses stereotactic computer-assisted (spatial frame) adjustment, including imaging.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,910.53
Total RVUs: 57.2
Global, days: 0
Region: General

Drawn from CMSAAPCMdclarityPayerpriceFindacode

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific external fixation system by type (e.g., spatial frame, Taylor Spatial Frame) and confirm it is a multiplane, unilateral construct.
Document the number of struts exchanged — 20697 is reported per strut, so each exchange must be individually noted in the operative or procedure record.
Confirm imaging was performed and document that it was used to guide or verify strut placement; imaging is bundled and cannot be billed separately.
Record the clinical indication for strut exchange — fracture correction progress, deformity correction stage, or hardware failure — tied to a supporting diagnosis code.
Document the date and place of service; strut exchanges on separate dates require separate claims, and in-office exchanges require documentation supporting that site of service.

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 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 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 7 cited references ↓

CPT 20697 covers each strut exchange performed on a unilateral multiplane external fixator that relies on stereotactic computer-assisted adjustment — the spatial frame construct used in complex fracture and deformity correction cases. The code is reported per strut, so if multiple struts are exchanged at the same encounter, bill 20697 for each one. Imaging is included in the work; don't separately bill fluoroscopy or other guidance used solely for the strut exchange.

The global period is 000, meaning only same-day pre- and post-procedure work is bundled. Strut exchanges that occur on subsequent dates — which is the norm in spatial frame treatment, where the prescription-driven adjustments require periodic hardware changes — are billed separately on each date of service without a postoperative period restricting reimbursement. This distinguishes 20697 from codes carrying 10- or 90-day globals.

Site of service matters here. HOPD and ASC reimbursement differ significantly (see the site-of-service comparison). Strut exchanges are often performed in the office or clinic when the patient's condition and frame access allow — confirm your MAC's coverage policy for place of service 11, since payer acceptance for in-office spatial frame work varies.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0
Practice expense RVU	57.17
Malpractice RVU	0.03
Total RVU	57.2
Medicare national rate	$1,910.53
Global period	0 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	$1,910.53
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI P2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 20697 get rejected.

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

Unbundling imaging (fluoroscopy) billed separately when it is already included in the 20697 descriptor.
Billing a single unit when multiple struts were exchanged, or conversely failing to document each exchange when billing multiple units.
Global period confusion when 20697 is billed during the postoperative period of the original external fixation application — modifier 58 or 79 required depending on whether the strut exchange is staged/related or unrelated.
Place-of-service mismatch when the procedure is performed in the office but billed under a facility rate, or when payer policy does not cover in-office spatial frame strut exchanges.
Missing or vague diagnosis linkage — claims without a clearly mapped fracture or deformity ICD-10 code are flagged for medical necessity review.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Is 20697 billed per strut or per encounter?

Per strut. If three struts are exchanged at one session, report 20697 three times with the appropriate units. Each exchange must be individually documented in the procedure note.

02Can fluoroscopy be billed separately with 20697?

No. Imaging is explicitly included in the 20697 descriptor. Separately billing fluoroscopy or other guidance used for the strut exchange will be denied as unbundling.

03What modifier applies when 20697 is billed during the postoperative period of the original fixator application?

Use modifier 58 if the strut exchange is a staged or related procedure anticipated as part of the spatial frame treatment plan. Use modifier 79 if the exchange is for an entirely unrelated reason. Modifier 78 applies only if the patient made an unplanned return to the OR for a related complication — rare for routine strut exchanges.

04Does 20697 have a global period that restricts follow-up billing?

The global period is 000, so only same-day pre- and post-procedure work is bundled. Subsequent strut exchanges on later dates are billed independently with no global restriction carried forward from a prior 20697 claim.

05Can 20697 be billed in the office setting?

Spatially, yes — many strut exchanges are performed in clinic. But payer acceptance for place of service 11 varies. Check your MAC's local coverage policies and confirm the spatial frame system documentation supports an in-office exchange before submitting.

06What is the difference between 20697 and the initial spatial frame application codes?

The initial application of a multiplane unilateral external fixator with stereotactic computer-assisted adjustment is reported with a different code in the 20690–20696 range. 20697 is specifically for the subsequent exchange — removal and replacement — of an individual strut, not the original frame construction.

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 spatial frame system name, confirmation that the construct is multiplane and unilateral, the number of struts removed and replaced, that imaging was performed intraprocedurally, the clinical reason for exchange (e.g., correction progression, strut failure), and the date and place of service. This prevents underbilling from a single-unit claim when multiple struts were exchanged and blocks separate fluoroscopy charges that payers deny as already included in 20697.

See how Mira captures CPT 20697 documentation