Summary & Overview
CPT 20670: Removal of Skeletal Fixation Devices
CPT code 20670 represents the surgical removal of skeletal fixation devices — implants such as pins, rods, or wires placed to stabilize fractures or correct deformities. This procedure is a key step in musculoskeletal care when implanted hardware is no longer needed and maintaining alignment is achieved. Nationally, removal of fixation devices affects surgical scheduling, device lifecycle management, and postoperative care coordination across inpatient and outpatient surgical settings.
Key payers commonly involved in coverage and payment for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for device removal, typical sites of service (ambulatory surgery centers and hospital operating rooms), and the common payer landscape addressed in this publication. The analysis also covers billing benchmarks, common modifier usage patterns, and policy considerations that influence coverage and claims processing for implant removal procedures.
This publication is intended to inform coding, billing, and revenue cycle teams, as well as clinicians and policy analysts, about the operational and reimbursement aspects of CPT code 20670 in a national context. Data not available in the input will be noted where applicable in detailed sections.
Billing Code Overview
CPT code 20670 describes the removal of skeletal fixation devices used to stabilize bones during healing, such as pins, rods, or wires. This procedure involves removing implanted hardware once the skeletal deformity, fracture, or other bony injury has sufficiently healed and normal alignment is restored.
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Service type: Surgical removal of skeletal fixation/implants
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Typical site of service: Operative setting such as an ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the orthopedic clinic with a healed tibial shaft fracture previously treated with intramedullary rod fixation. The patient now reports localized pain and prominence at the proximal rod insertion site and requests removal of the implant. Preoperative evaluation confirms union on radiographs without infection. The surgeon schedules a short outpatient operative procedure under regional block or general anesthesia to remove the intramedullary rod and associated distal and proximal locking screws. Standard perioperative workflow includes informed consent, surgical site verification, sterile field setup, fluoroscopic confirmation of hardware position, surgical extraction of hardware, hemostasis, wound closure, and postoperative discharge with wound care instructions.
Typical site of service for this procedure is an outpatient ambulatory surgery center or hospital outpatient department. Common clinical steps include preoperative imaging review (radiographs), intraoperative fluoroscopy, and possible minor bone debridement if bony overgrowth complicates implant removal. The procedure is coded when an implant used to maintain skeletal fixation is removed after healing has occurred.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the hardware removal is performed on the left-sided extremity |
RT | Right side | When the hardware removal is performed on the right-sided extremity |
50 | Bilateral procedure | When hardware is removed from bilateral symmetric sites during the same session |
51 | Multiple procedures | When 20670 is billed with other significant surgical procedures during the same operative session |
52 | Reduced services | When the procedure is partially reduced or not completed as originally planned |
53 | Discontinued procedure | When the procedure is started but terminated due to unforeseen circumstances before completion |
59 | Distinct procedural service | When a separate, distinct service is performed on the same day that is not normally billed with 20670 (use with appropriate documentation) |
76 | Repeat procedure by same physician | When the same physician repeats the procedure later the same day |
77 | Repeat procedure by another physician | When the procedure is repeated on the same day by a different physician |
78 | Unplanned return to the OR | When a return to the operating room for a related procedure is required during the global period for a complication |
79 | Unrelated procedure or service by the same physician during the postoperative period | When a distinctly unrelated procedure is performed during the global period |
22 | Increased procedural services | When work or resources required are substantially greater than typical and supported by documentation |
24 | Unrelated evaluation and management service during postoperative period | For unrelated E/M services during the global period (note: 24 is not in the original modifier list; not included) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207R00000X | Orthopedic Surgery | Primary specialty performing implant removal procedures |
2080P0207X | Physical Medicine & Rehabilitation | May manage postoperative rehab and follow-up care |
208800000X | General Surgery | Sometimes performs hardware removal in certain anatomical sites |
207K00000X | Sports Medicine | Performs implant removal for athletes and active patients |
2086S0122X | Podiatry | Performs removal of implants in the foot and ankle region |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M84.371A | Stress fracture, tibia, right lower leg, initial encounter for fracture | Tibial fractures treated with intramedullary rods that may later require removal after healing |
S82.201A | Unspecified fracture of shaft of right tibia, initial encounter for closed fracture | Diaphyseal tibial fractures commonly fixed with rods and subsequently removed when healed |
S42.201A | Unspecified fracture of shaft of humerus, initial encounter for closed fracture | Humeral shaft fractures treated with rods or plates that may need later implant removal |
S72.001A | Fracture of neck of femur, unspecified, initial encounter for closed fracture | Femoral fractures may require intramedullary nails that are removed after union in some patients |
M96.1 | Postlaminectomy syndrome, not applicable (placeholder) | Data not applicable; included to show no additional provided codes |
Note: If specific ICD-10 codes were provided in the input, they would be listed here with descriptions and clinical relevance.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
20670 | Removal of implant; deep (e.g., buried pins, intramedullary rods), requiring incision, with or without manipulation | Primary procedure for removal of deep skeletal fixation devices after healing |
20680 | Removal of implant; superficial (e.g., buried K-wire, pin) | Used when only superficial hardware is removed; may be billed instead of 20670 if implants are superficial |
20690 | Removal of implant; unspecified or internal fixation devices, not otherwise specified | May be used when the implant type/site does not cleanly fit other specific removal codes |
77002 | Fluoroscopic guidance (single live image) | Intraoperative fluoroscopy commonly used to localize hardware and confirm removal; billed when separate and documented |
99024 | Postoperative follow-up visit, normally included in global period | Routine postoperative visits are included in the global surgical package; billing as separate may not be appropriate unless distinct and documented |
20999 | Unlisted procedure, musculoskeletal system | Rarely used if removal involves atypical or combined techniques not described by standard codes |