CPT Code Overview

CPT 20680 describes the removal of a deep implant, such as a buried wire, pin, screw, metal band, nail, rod, or plate. This procedure is categorized under Surgical – Musculoskeletal system services and typically occurs in the Outpatient Hospital (POS 22) setting. The code covers surgical extraction of hardware that is located beneath the superficial tissues and often requires dissection to access and remove the implant.

Data not available in the input.

Clinical Context

A 45-year-old patient presents to an outpatient hospital orthopedic clinic with persistent localized pain and decreased function at a prior fracture fixation site of the femur. Imaging confirms a healed fracture with a retained deep plate and screws causing irritation. The orthopedic surgeon schedules removal of the deep implant under regional or general anesthesia in an outpatient hospital setting (POS 22). The clinical workflow includes preoperative evaluation, consent, perioperative antibiotics as indicated, operative removal of the buried plate and screws with hemostasis and wound closure, and brief postoperative recovery with discharge instructions and follow-up for wound check.

Coding Specifications

• Modifier 22 — Increased procedural services

  Use when work required to remove the deep implant is substantially greater than typically required for 20680 (for example, extensive dissection, unexpected hardware corrosion or bone overgrowth) and documentation supports the additional work.

• Modifier 50 — Bilateral procedure

  Use when identical deep implant removal is performed on both sides during the same operative session and documentation specifies bilateral procedures.

• Modifier 59 — Distinct procedural service

  Use when 20680 represents a procedure that is distinct and separate from other services performed at the same session (for example, a separate surgical encounter on a different anatomic site), with documentation supporting separate identifiable procedures.

• Associated provider taxonomies and specialties:

Related Diagnoses

• T84.84XA — Pain due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

  Clinically relevant when the patient presents with acute or initial postoperative pain attributable to the implanted hardware that may prompt deep implant removal.

• T84.84XD — Pain due to internal orthopedic prosthetic devices, implants and grafts, subsequent encounter

  Relevant for follow-up encounters for ongoing or recurrent pain from retained deep implants leading to consideration of 20680.

• T84.84XS — Pain due to internal orthopedic prosthetic devices, implants and grafts, sequela

  Relevant when chronic sequelae from implant-related complications (for example, late pain or dysfunction) are the reason for removal of the deep implant.

• T84.82XA — Fibrosis due to internal orthopedic prosthetic devices, implants and grafts, initial encounter

  Clinically relevant when fibrotic reaction around hardware causes pain or functional limitation, prompting deep implant removal.

• T84.82XD — Fibrosis due to internal orthopedic prosthetic devices, implants and grafts, subsequent encounter

  Relevant for follow-up care of fibrosis-related complications from implants that may require 20680 for symptom relief.

Related CPT Codes

• Common usage notes:

• 20670 is commonly used as an alternative when implant removal is superficial.

• 29805 may be performed in the same operative course if arthroscopic evaluation is also required; use modifier 59 when appropriate to indicate distinct procedural services.

National average commercial (BUCA) mean allowed rate for CPT 20680 is $691.98, which is modestly higher than the Medicare mean of $651.67. The difference between Medicare and BUCA is $40.31, indicating commercial averages sit above the Medicare benchmark but within a relatively narrow band compared with some commercial payers.

Rate dispersion (P75 − P25) varies substantially by payer. Cigna and UnitedHealth Group show the widest spreads at $476.00 and $564.75 respectively, indicating greater variability in allowed rates. Aetna and Medicare are the tightest, with ranges of $247.17 and $67.00 respectively. The table and chart below present the full percentile breakdown and mean rates for each payer.