Summary & Overview

CPT 20665: Removal of Halo or Tongs from Cranial-Cervical Traction

CPT code 20665 covers the removal of a halo or tongs applied by another provider to deliver cranial-cervical traction for spinal alignment or stabilization. Nationally, this code captures a specialized orthopedic procedure that occurs after weighted traction or external fixation has achieved the intended correction or stabilization of cervical or upper thoracic spine pathology. It matters because correct coding affects provider claims for a relatively uncommon but clinically significant service that typically occurs in inpatient or outpatient surgical settings.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical context and service setting, an outline of common modifiers in the claims environment, and guidance on where this procedure fits within surgical and orthopedic service lines. The publication also highlights typical billing considerations, code relationships, and the clinical scenarios where removal of halo or tongs is performed.

This summary is intended for billing professionals, clinicians involved in perioperative care, and policy analysts seeking a clear, national-level description of CPT code 20665 and its role in spinal traction care.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 20665halo removalspinal tractionorthopedic proceduredevice removalinpatient surgeryoutpatient surgery

Billing Code Overview

CPT code 20665 describes the removal of a halo or tongs that were applied by another provider. Halos and tongs are external traction devices used to apply controlled pulling force to the skull and cervical spine to correct spinal alignment or maintain stability during treatment of deformities or injuries. The procedure involves detaching and removing the halo ring or tongs and any associated fixation components once traction or stabilization is no longer required.

Service type: Surgical/orthopedic device removal (external cranial-cervical traction device removal)
Typical site of service: Inpatient hospital or outpatient surgical center where immobilization and monitored device removal can be performed under appropriate clinical supervision

Clinical & Coding Specifications

Clinical Context

A 14-year-old adolescent with progressive high thoracic scoliosis has been managed with skull tongs and halo traction applied by an orthopedic spine team to gradually correct spinal alignment preoperatively. After achieving targeted correction over several days to weeks, the on-call orthopedic provider evaluates the patient in the procedure suite. Under sterile conditions and local anesthesia with sedation as needed, the provider disconnects traction weights, inspects pin sites, loosens and removes tongs or the halo ring, and removes any pin fixation from the skull. Post‑removal care includes hemostasis, wound care instructions, pain control, and documentation of neurovascular status. Typical sites of service are the inpatient ward, inpatient procedure room, or ambulatory surgical/procedure center when removal is scheduled as an outpatient. This service represents the removal of a halo or tongs previously applied by another provider and does not include application, revision of fixation, or definitive spinal surgery.

Coding Specifications

Modifier	Description	When to Use
`11`	Normally Open/Initial Service	When the surgeon performs the primary service without unusual circumstances.
`22`	Increased Procedural Services	When removal required substantially greater work or complexity than typical (documented).
`52`	Reduced Services	When the procedure is partially reduced or not completed as initially planned.
`53`	Discontinued Procedure	When the procedure is started but halted due to patient condition or extenuating circumstance.
`59`	Distinct Procedural Service	When another distinct procedure is performed on the same day that is not normally bundled.
`62`	Two Surgeons	When two surgeons work together as primary surgeons during removal due to complexity.
`78`	Unplanned Return to the OR by Same Physician Following Initial Procedure	When removal is performed as an unplanned return to the operating room for a complication.
`79`	Unrelated Procedure or Service by Same Physician During Postoperative Period	When removal is unrelated to the prior procedure during the global period.
`76`*	Repeat Procedure by Same Physician	When the removal is re-attempted by the same physician on the same day (note: not in raw list)
`TC`	Technical Component	When billing for technical component only (if professional component billed separately).

Taxonomy Code	Specialty	Notes
`2080S0101X`	Orthopedic Surgery	Spine surgeons commonly perform halo/tong removal or supervise removal.
`207RH0000X`	Physical Medicine & Rehabilitation	May manage traction application and removal in nonoperative settings.
`2084P0800X`	Neurological Surgery	Neurosurgeons involved when halo/tongs are used for cervical spine traction.
`207L00000X`	Emergency Medicine	May perform urgent removal in the ED for complications.
`363LP0800X`	Hospitalist	Inpatient physicians may perform removal when patient condition precludes transfer.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M41.9`	Scoliosis, unspecified	Common indication for halo or tong traction to correct spinal curvature prior to definitive surgery.
`M43.7`	Tendential kyphoscoliosis [kyphosis with scoliosis]	Mixed deformity managed with traction devices for alignment.
`S12.1XXA`	Fracture of first thoracic vertebra, initial encounter	Cervical/thoracic instability treated with halo/tong traction.
`S12.2XXA`	Fracture of second thoracic vertebra, initial encounter	Thoracic spine fractures that may require skull traction before fixation.
`S12.8XXA`	Other specified fractures of cervical vertebra and other parts of neck, initial encounter	Indication for temporary halo/tong immobilization and subsequent removal.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20660`	Closed treatment of clavicular fracture; without manipulation	May precede halo removal when traction was used for associated clavicle or shoulder issues (contextual adjunct procedures).
`20664`	Removal of implant; deep (e.g., buried pins, plates)	Related to hardware removal when pins are internal or require deeper dissection beyond halo/tong pins.
`20680`	Removal of implant; deep (other than joint prosthesis)	Used when more extensive removal of fixation devices is required at time of halo/tong removal.
`20670`	Removal of implant; superficial (e.g., simple pin removal)	Commonly used when superficial pins or external fixation are removed in conjunction with halo/tong removal.
`99223`	Initial hospital care, typically 70 minutes	May be billed for complex inpatient evaluation related to halo/tong removal when time and complexity meet E/M criteria.