For bilateral administration of HYALGAN, some payers may require modifier “-50” (bilateral procedure) to be documented after CPT code 20610. In addition payers may require EJ modifier, usually following the first injection, to indicate subsequent injections in a series of injections.
All settings should bill Synvisc-One as 3 units of code J7322.
Billing the injection procedure The procedure code (CPT code) 20610 may be billed for the intraarticular injection.
When this injection is administered either unilaterally or bilaterally the injections would be billed by placing J7325 in item 24 (FAO-09 electronically) and listing the total number of mg's administered in the units field.
The new HCPC code, J7325, is reported for both Synvisc and Synvisc One, the injection code is easy, and so we will start there— Bill using CPT 20610. The reporting of Synvisc is dependent on what drug you are using. Synvisc One: is a concentrated dose, is only administered one time and is reported with 48 units.
HCPCS code J7325 for Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg as maintained by CMS falls under Miscellaneous Drugs .
Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. You may report multiple units of a single code for aspiration/injection of multiple joints of same size (e.g., two large joints, left knee and left shoulder).
Use 20610 for a major joint or bursa, such as the shoulder, knee, or hip joint, or the subacromial bursa when no ultrasound guidance is used for needle placement. Report 20611 when ultrasonic guidance is used and a permanent recording is made with a report of the procedure.
An intra-articular injection is a type of shot that's placed directly into a joint to relieve pain. Corticosteroids (steroids), local anesthetics, hyaluronic acid, and Botox are the most common substances injected into joints for this treatment.
You may report the injection using 20610 and the drug supply using J7323 Hyaluronan or derivative, Euflexxa, for intra-articular injection, per dose (once unit, per dose) linked to a diagnosis of M17.
HCPCS code J7324 for Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose as maintained by CMS falls under Miscellaneous Drugs .
GELSYN-3 has a dedicated J code of J7328.Providers should bill 168 units of HCPCS code J7328 for the single injection of GELSYN-3, as J7328 reimburses per 0.1 mg.