Summary & Overview
CPT 20662: Halo Pelvic Fixation for Spinal Traction and Immobilization
CPT code 20662 denotes halo pelvic fixation, a surgical traction and immobilization procedure used to correct spinal curvature or dislocation and to stabilize the spine. It covers placement of a pelvic hoop with pins, a skull halo, and vertical connecting bars, and includes removal of the pelvic halo. This code is relevant nationally for spine surgery programs, trauma centers, and orthopedics and neurosurgery practices that manage severe deformity, lumbosacral spondylolisthesis, scoliosis, and tuberculous kyphosis.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and what to expect in billing and claims workflows for this specialized fixation procedure. The publication highlights national benchmarks where available, recent policy or coding updates affecting utilization and coverage, and clinical considerations that commonly accompany claims for complex spinal traction and immobilization. Data not available in the input where relevant will be noted.
Billing Code Overview
CPT code 20662 describes halo pelvic fixation, a procedure that applies traction force for correction of spinal curvature or dislocation and for immobilization of the spine. The pelvic halo construct includes a pelvic hoop with two pins, a skull halo, and four vertical threaded bars connecting the pelvic hoop and skull halo. The service explicitly includes removal of the pelvic halo as part of the procedure.
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Service type: Surgical fixation/traction procedure for spinal correction and immobilization
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Typical site of service: Inpatient or outpatient operating room or procedure suite where spinal fixation/traction devices are applied and removed
Clinical & Coding Specifications
Clinical Context
A 16-year-old adolescent with progressive idiopathic scoliosis presents with a 70-degree thoracolumbar curvature and significant trunk imbalance after failed conservative management (brace and observation). The orthopedic spine surgery team elects to place a halo pelvic fixation to apply gradual traction and correct spinal deformity prior to definitive posterior spinal fusion. The typical workflow includes preoperative assessment (imaging, neurologic baseline exam), placement of a skull halo and pelvic hoop with two pelvic pins under general anesthesia in the operating room, connection with four vertical threaded rods, staged traction adjustments while inpatient, regular neurovascular and pin-site checks, imaging to monitor correction, and eventual removal of the pelvic halo once adequate alignment or immobilization has been achieved. The documented service includes placement and application of traction and removal of the pelvic halo when performed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity substantially exceeds typical for halo pelvic fixation (document rationale). |
23 | Unusual anesthesia | Use when procedure is performed under general anesthesia but unusual circumstances increase anesthesia risk without changing primary code. |
24 | Unrelated E/M service during postoperative period | Use if an unrelated evaluation and management visit occurs during the global period (not in provided list but excluded per rules). |
26 | Professional component | Use when reporting only the physician’s professional component of a service (e.g., interpretation if applicable). |
52 | Reduced services | Use when procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when procedure is started but discontinued due to extenuating circumstances. |
62 | Two surgeons | Use when two surgeons from different specialties perform distinct surgical portions of the case. |
78 | Unplanned return to the OR by the same physician following initial procedure for related procedure during postoperative period | Use for emergent return to OR for complications related to halo pelvic fixation. |
80 | Assistant surgeon | Use when a surgical assistant participates and billing requires this modifier. |
81 | Minimum assistant surgeon | Use when a minimal assistant role is provided and reported accordingly. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207XS0100X | Orthopaedic Surgery | Primary specialty performing spinal deformity procedures and halo pelvic fixation. |
| 2084P0800X | Physical Medicine & Rehabilitation | Manages pre- and postoperative traction care and rehabilitation while halo is in place. |
| 207L00000X | Neurological Surgery | May perform or assist in complex spinal deformity cases requiring halo traction. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M41.9 | Scoliosis, unspecified | Common indication for halo pelvic fixation to correct severe spinal curvature when conservative care fails. |
M43.17 | Spondylolisthesis, lumbosacral region | Halo traction can be used for immobilization and gradual correction of severe spondylolisthesis. |
M49.07 | Tubercolous spondylitis of lumbar region (use as representative of tuberculous kyphosis) | Tuberculous kyphosis may require halo pelvic fixation for correction and immobilization during treatment. |
| M48.06 | Spinal stenosis, lumbar region | Severe deformity with instability may be managed temporarily with halo traction (code presented without backticks due to input conventions). |
S32.000A | Unspecified fracture of lumbar vertebra, initial encounter for closed fracture | Traction and immobilization with a pelvic halo may be used in selected unstable fractures prior to definitive fixation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
20660 | Removal of implant; deep (e.g., buried wire, pins, plates, screws) | May be used if additional deep pelvic or cranial pin removal is performed separately from the described pelvic halo removal. |
20690 | Removal of implant; deep (unlisted procedure) | Used if the specific removal service is not represented by an existing code or for complex removal beyond standard pelvic halo removal. |
22851 | Application of intervertebral biomechanical device(s) (e.g., spinal instrumentation) | Performed during definitive fusion following halo traction as part of corrective surgery. |
22842 | Posterior segmental instrumentation (e.g., multiple vertebral levels), thoracic | May be performed after halo traction during corrective spinal fusion. |
22845 | Anterior instrumentation; thoracolumbar | Alternative or adjunct instrumentation code used in definitive fusion after traction correction. |