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 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.
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The codes for reporting TPs include: Injection (s); single or multiple trigger point (s); 20552 1 or 2 muscle (s) 20553 3 or more muscles
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 the pain can be felt in other parts of the body, including the back and neck.
Multiple trigger points may be injected during any one session (see procedure codes 20552 and 20553). Some trigger points may need to be re-injected weekly or monthly for brief intervals consisting of a few months, depending on the results of the injections and the relief of pain that the injection provides.
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.
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.
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 ...
Group 1CodeDescription20552INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)20553INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES
Trigger point injections are not truly nerve blocks; rather they are muscle blocks. Muscles that are chronically tense or in spasm become tender and painful.
A Medicare beneficiary must be diagnosed with myofascial pain syndrome (MPS), which is a chronic pain disorder, in order for Medicare to cover trigger point injections. A doctor or provider will review the beneficiary's medical history and complete an exam of the patient to make this diagnosis.
CPT code 20550 defines an injection to the tendon sheath; CPT code 20551 defines an injection to the origin/insertion site of a tendon. CPT code 20550 is frequently used for a trigger finger injection, where the injection is administered to the tendon sheath.
HOW TO BILL BILATERAL TRIGGER POINT INJECTION20552 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.
CPT code 20550 should be reported once per cord injected regardless of how many injections per session. For the initial evaluation and injection, the appropriate E&M code (with modifier 25) may be submitted with the injection code.
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. Only 20552 or 20553 may be billed, not both.
TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.
TPIs are given to painful areas of muscle that contain trigger points or knots of muscle that form when muscles fail to relax. An epidural is an injection that is given in the space just outside the membrane that protects the spinal cord.
Steroid injections, or large point injections, are different from nerve blocks only in that they provide a steroid medication in the injection versus an intense numbing agent. The goal of a steroid injection is to provide the joint and body with help to reduce inflammation in order to reduce pain.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
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.
The following coding and billing guidance is to be used with its associated Local coverage determination.
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.
All ICD-10-CM codes not listed in this policy under ICD-10-CM Codes That Support Medical Necessity above.
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.
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.
Trigger point injection therapy is a common procedure performed by pain management specialists, orthopedic surgeons, physical medicine and rehab and other specialties. Trigger point injection therapy is used for the treatment of myofascial pain syndrome (MPS). According to the American Society of Regional Anesthesia and Pain Medicine.
There are two CPT ® codes for Trigger point injections: 20552-Injection (s); single or multiple trigger point (s), 1 or 2 muscle (s) ...
Up to 4 sets of injections are considered medically necessary to diagnose the origin of the patient’s pain and to achieve a therapeutic effect; additional sets of trigger point injections are not considered medically necessary if not clinical response is achieved.