CPT Code 20680: Removal of Implant; Deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)

What is deep implant removal?

CPT code 20680 is used when a surgical procedure involves the removal of the support structures such as a buried wire, pin, screw, metal band, nail, rod or plate from deep tissue or bone. This procedure requires dissection down to the implant, often performed in an operating room, and is distinct from superficial implant removals due to the increased complexity and depth.

This code is commonly used when a qualified health care professional removes orthopedic hardware due to infection, pain, implant failure, or completion of healing. CPT 20680 represents a distinct procedural service, especially if performed by the same physician during the postoperative period, and may require appropriate modifiers to avoid denials.

As clarified by the American Academy of Orthopaedic Surgeons (AAOS) and AAPC, accurate use of this code ensures correct Medicare reimbursement and documentation of medical necessity when hardware is deeply embedded in bone or tissue.

Documentation requirements

When reporting CPT code 20680 for deep implant removal, comprehensive and specific documentation is essential to ensure appropriate billing and support for medical necessity.

Include the following details:

• Indication for removal: Document the reason, such as infection, implant failure, or persistent pain, to justify the distinct procedural service.
• Implant details: Specify the type of implant the health care professional used (e.g., rod, pin, screw, metal band), its location, and that it was deeply embedded, requiring surgical dissection.
• Surgical technique: Describe the operative approach, including dissection down to the hardware, tools used, and whether the procedure was performed in an operating room.
• Anesthesia and tolerance: Note the type of anesthesia used and how the patient tolerated the procedure, especially if it occurred during the postoperative period.
• Multiple implants: If more than one implant was removed, indicate if removals occurred at the same site or different anatomical locations to determine whether additional reporting or modifiers apply.

It's also important to clarify whether the service was performed during the postoperative period, used for the original surgery, as this impacts modifier use and reimbursement.

Billing guidelines

CPT code 20680 should be reported once per incision site, even when multiple implants (e.g., pin, screw, metal band, rod, or plate) are removed. If more than one implant is removed through a single incision, do not bill separately unless the complexity of the hardware removal is documented and justified as a distinct procedure by the same physician.

This code cannot be reported alongside surgical procedures in which implant removal is considered bundled. In such cases, CPT code 20680 is not separately reimbursable. Moreover, code 20680 should not be used for removing wire sutures during cardiac or sternal procedures, such as reoperation or sternotomy closure.

To support accurate billing, ensure the qualified health care professional documents the medical necessity of the procedure and that the implant was deeply embedded, requiring operative dissection. This is particularly important when billing Medicare, as CPT code 20680 Medicare reimbursement is determined by Medicare Administrative Contractors (MACs) according to postoperative period guidelines and the medicare physician fee schedule (MPFS).

Proper billing practices help bring clarity to your revenue cycle, avoid claim denials, and maintain compliance.