What is the difference between CPT code 20550 and 20551?
What is the difference between 20550 and 20551? 20550: Injection (s), single tendon sheath. 20551: Injection (s), single tendon origin. As with 20550, it does not matter how many times the physician administers injections; report 20551 once. Be sure to note that the injection is into the origin, where the tendon connects to the muscle.
How to Bill CPT 20550?
tendon/ligament injections (20550), or needle placements, etc. (Use finger and toe modifiers for finger and toe procedure codes; use eyelid modifiers for eyelid procedures.) If the code description is for a structure that occurs multiple times on one side of the body (e.g. fingers, tendons, nerves, etc.) and is not specific enough for you to
How to Bill 20552?
Reproduction of referred pain pattern upon stimulation of trigger point.
- History of onset of the painful condition and its presumed cause (e.g., injury or sprain).
- Distribution pattern of pain consistent with the referral pattern of trigger points.
- Range of motion restriction.
- Muscular deconditioning in the affected area.
- Focal tenderness of a trigger point.
- Palpable taut band of muscle in which trigger point is located.
Does CPT code 20552 need a modifier?
When billing for non-covered services, use the appropriate modifier. Only one code from 20552 or 20553 should be reported on any particular day, no matter how many sites or regions are injected. Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.
How do I bill a CPT 20552?
Effective March 1, 2017, Any combination of trigger point injections, CPT codes 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) and 20553 (Injection(s); single or multiple trigger point(s), 3 or more muscles), when billed >3 times in a 90-day period, for the same anatomic site, without ...
Does CPT code 20552 need a modifier?
Key point to remember! - these 2 CPT Codes 20552, 20553 DO NOT NEED A MODIFIER!
Does 20610 and 20552 need a modifier?
Answer: You are correct, trigger point injection (20552 or 20553) and a joint injection, for example, a shoulder joint injection, (20610) are bundled by Medicare. You will note, however, that a modifier is allowed to override this edit.
Will Medicare pay for trigger point injections?
Trigger point injections are typically covered by Medicare Part B, and because Medicare Advantage (Medicare Part C) plans are required to cover at least everything Medicare Part B and Part A cover, Medicare Advantage plans may also cover trigger point injections.
Is CPT 20552 covered by Medicare?
Effective January 21, 2020, Medicare will cover all types of acupuncture including dry needling for chronic low back pain within specific guidelines in accordance with NCD 30.3. 3. For trigger point injections, use code 20552 for one or two muscle groups injected, or 20553 for three or more muscle groups.
Does CPT code 20552 include the medication?
Because this code specifies a number of muscles injected, not a particular amount of medication or number of injections, you'll report 20552 because only two muscles (trapezius and levator scapulae) were injected.
How do I bill Medicare for joint injections?
Billing the injection procedure The procedure code (CPT code) 20610 may be billed for the intraarticular injection. The charge, if any, for the drug or biological must be included in the physician's bill and the cost of the drug or biological must represent an expense to the physician.
How do you bill trigger point injections?
There are two CPT® codes for Trigger point injections:20552-Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)20553-Injection(s); single or multiple trigger point(s), 3 or more muscles.
How do you bill multiple trigger finger injections?
CPT code 20550 is frequently used for a trigger finger injection, where the injection is administered to the tendon sheath.
Can 20552 be billed bilaterally?
Remember that these codes CPT 20552, 20553 are NOT billable as unilateral. Modifier 50 (bilateral) will NOT apply. Bill by the number of muscles! Got more questions?
Can you bill an office visit with a trigger point injection?
The office visit is allowed and should be billed with the modifier -25 because the decision to give the injections was made after the examination.
Does Medicare pay for myofascial?
Most patients and massage therapists are not aware of the fact that "massage therapy" and/or "manual therapy techniques/myofascial release" is a covered service by most insurers, including Medicare and self-insured employer plans which fall under the Federal guidelines of ERISA (Employee Retirement Income Security Act) ...
What is 20553 injection?
20553 Injection (s); single or multiple trigger point (s), 3 or more muscle (s) Trigger Point Injections are used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Trigger points may irritate the nerves around them and cause pain at the site of the trigger point or ...
What is the CPT code for a single trigger point?
CPT/HCPCS Codes. 20552 Injection (s); single or multiple trigger point (s), one or two muscle (s) 20553 single or multiple trigger point (s), three ...
Does Medicare cover acupuncture?
Acupuncture is not a covered service, even if provided for the treatment of an established trigger point. Use of acupuncture needles and/or the passage of electrical current through these needles is not covered (whether an acupuncturist or other provider renders the service). Medicare does not cover Prolotherapy.
Does Medicare cover prolotherapy?
Medicare does not cover Prolotherapy. Its billing under the trigger point injection code is a misrepresentation of the actual service rendered. Only one code from 20552 or 20553 should be reported on any particular day, no matter how many sites or regions are injected.
Is a trigger point injection considered a reasonable treatment?
The injection of trigger point (s) will be considered to be medically reasonable and necessary for the treatment of trigger points that are unresponsive to non-invasive treatments or when non-invasive methods of treatment are contraindicated.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33912 Injection of Trigger Points provides billing and coding guidance for diagnosis limitations that support diagnosis to procedure code automated denials.
ICD-10-CM Codes that Support Medical Necessity
The following ICD-10-CM codes support medical necessity and provide limited coverage for CPT codes: 20552 and 20553.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Pain Management. Coding Information: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits.
ICD-10-CM Codes that Support Medical Necessity
The use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the attached determination.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.