How do I bill a CPT 20552? For trigger point injections, use code 20552 for one or two muscle groups injected, or 20553 for three or more muscle groups. The number of services for either code is one (1), regardless of the number of injections at any individual site, and regardless of the number of sites.
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.
Does CPT code 20552 need a modifier?
Key point to remember! - these 2 CPT Codes 20552, 20553 DO NOT NEED A MODIFIER!
Can CPT code 20552 be billed bilaterally?
Take-away! Remember that these codes CPT 20552, 20553 are NOT billable as unilateral. Modifier 50 (bilateral) will NOT apply.
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.
How do you bill multiple 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 for ultrasound guided injections?
CPT Code 76942, Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection and localization device), imaging supervision and interpretation, is an appropriate code for certain procedures when performed. In these cases, the primary injection code is billed in addition to 76942 for ultrasound guidance.
How do you code multiple tendon sheath injections?
Per the CPT guidelines, if multiple injections are performed into the same tendon sheath/origin, then codes 20550 or 20551 should only be reported only once. If there are multiple injections into multiple sites, then you may report codes 20550 or 20551 once per injection.
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.
How do you document trigger point injections?
When coding for trigger point injections, the documentation must include the site of the injection, the total number of injections and the number of muscles involved. In addition, documentation must also support that various conservative therapies have been tried and failed.
How do you bill radiofrequency ablation?
Pulsed radiofrequency ablation should be reported using CPT code 64999.”
How do I bill Medicare for trigger point injections?
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 include ultrasound guidance?
There does happen to be a CPT Assistant in place stating that u/s can be billed with 20552, but that it is only billed once no matter how many trigger points are injected.
When do you use modifier 58?
Modifier 58 is used for a “staged or related procedure or service by the same physician during the post-operative period.” Further, according to CMS.gov, modifier 58 indicates that the procedure was: Planned, either at the time of the first procedure or prospectively.
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.
CMS National Coverage Policy
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
Article Guidance
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35010, Trigger Point Injections. Please refer to the LCD for reasonable and necessary requirements.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted. The following ICD-10 CM codes support medical necessity and provide coverage for CPT/HCPCS codes 20552 and 20553:
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this policy.
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.
CMS National Coverage Policy
Title XVIII of the Social Security Act, §1862 (a) (1) (A). Allows coverage and payment for only those services that are considered to be medically reasonable and necessary. Title XVIII of the Social Security Act, §1833 (e). Prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Article Guidance
The following coding and billing guidance is to be used with its associated Local coverage determination.
ICD-10-CM Codes that Support Medical Necessity
These are the only covered ICD-10-CM codes that support medical necessity. This A/B MAC will assign the following ICD-10-CM codes to indicate the diagnosis of a trigger point. Claims without one of these diagnoses will always be denied.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All ICD-10-CM codes not listed in this policy under ICD-10-CM Codes That Support Medical Necessity above.
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.
