Removal of an intramedullary drug delivery device from the bone marrow canal, reported as an add-on to the primary procedure code.

Verified May 8, 2026 · 5 sources ↓

Medicare: $108.55
Work RVU: 1.76
Global, days
Region: General

Drawn from CMSAAPCPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify that the device removed was intramedullary — seated within the medullary canal of a named bone, not merely subfascial or deep soft tissue.
Identify the primary procedure being performed and confirm 20703 is appended to that primary code on the claim.
Document the reason for removal (e.g., completion of drug delivery course, device failure, infection, planned staged exchange).
Record the surgical approach, intraoperative findings, and confirmation that the device was fully extracted.
Note any imaging guidance used intraoperatively and whether it is separately reportable or integral to the primary procedure.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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 20703 covers the removal of a previously placed intramedullary drug delivery device — one seated within the medullary canal of a bone — performed as part of a larger surgical encounter. Because it is an add-on code, it is never reported alone; it always accompanies the primary procedure code that describes the main surgical work being done at that session.

The ZZZ global period means 20703 folds into the global package of the primary procedure it accompanies. There is no separate pre- or post-operative period assigned to this add-on. Modifier 51 is not applied to add-on codes, and payers expect to see the primary procedure listed first on the claim.

Distinguish 20703 from its companion codes: 20701 covers removal of a deep (subfascial) device — not intramedullary — and 20702 covers manual preparation and insertion of a deep device. If you're removing a device from inside the bone marrow canal specifically, 20703 is the correct add-on. Using the wrong removal code is a common source of edits.

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 (1.76) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.25) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.76
Practice expense RVU	1.11
Malpractice RVU	0.38
Total RVU	3.25
Medicare national rate	$108.55
Global period	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	$108.55

Common denial reasons

The recurring reasons claims for CPT 20703 get rejected.

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

Billing 20703 as a standalone code rather than as an add-on to a primary procedure — payers will reject it without a paired primary.
Misidentifying device depth: using 20703 when the device removed was subfascial rather than truly intramedullary, conflating it with 20701.
Applying modifier 51 to 20703 — add-on codes are exempt from multiple-procedure reduction and modifier 51 should not appear on this code.
Insufficient operative note detail to confirm intramedullary location; an auditor reading only 'device removed' cannot validate the correct code selection.

Frequently asked questions

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

01Can I bill 20703 without a primary procedure code?

No. 20703 is an add-on code with a ZZZ global period. It must be reported in addition to the primary procedure code. A claim with only 20703 will be rejected.

02Should I apply modifier 51 to 20703?

No. Add-on codes are exempt from modifier 51 and the associated multiple-procedure payment reduction. Applying it incorrectly can trigger a downward payment adjustment or a payer edit.

03What is the difference between 20703 and 20701?

20703 is for removal of an intramedullary device — one placed inside the bone marrow canal. 20701 is for removal of a deep (subfascial) device that is not intramedullary. The anatomic depth of the device determines which code applies.

04Does the ZZZ global period mean there is no postoperative period for 20703?

Correct. ZZZ indicates the code always accompanies another procedure and has no independently assigned pre- or postoperative period. Post-op follow-up is governed by the global period of the primary procedure.

05If the patient returns for a planned second-stage removal of the device, which modifier applies?

Use modifier 58 on the primary procedure for the return encounter to indicate a staged or related procedure during the postoperative period of the original surgery. Append 20703 as the add-on to that primary code without modifier 58 on 20703 itself.

06Is fluoroscopy separately billable when used to confirm complete removal of the intramedullary device?

Only if the primary procedure's code descriptor does not already include radiologic guidance. Per NCCI 2026 policy, if imaging guidance is integral to the primary procedure, it cannot be billed separately. If the primary procedure does not include guidance and fluoroscopy is a distinct service, it may be separately reportable with an NCCI-associated modifier if appropriate.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the device location (intramedullary, with the specific bone named), the reason for removal, and explicit confirmation that extraction was complete — then links that dictation to the primary procedure code. This prevents the most common edit: a claim where 20703 appears without a clearly documented primary procedure or where chart language doesn't confirm the canal-level depth that separates 20703 from 20701.

See how Mira captures CPT 20703 documentation