How To Use CPT Code 20560

CPT 20560 refers to needle insertion(s) without injection(s) into 1 or 2 muscle(s) for pain relief. This article covers the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 20560.

1. What is CPT 20560?

CPT 20560 is a medical procedure code used to describe the insertion of a needle, without medication, into one or two muscles to help relieve pain. This technique is commonly performed by physical therapists and is used to treat various conditions such as pain, impaired movement, fibromyalgia, and tension headaches. It is also known as trigger point acupuncture or dry needling.

2. 20560 CPT code description

The official description of CPT code 20560 is: “Needle insertion(s) without injection(s); 1 or 2 muscle(s)”.

3. Procedure

The 20560 procedure involves the following steps:

1. The provider cleans the site where the needle will be inserted.
2. A fine filiform disposable needle is prepared for insertion.
3. The provider identifies the trigger point in the muscle(s) to be treated.
4. The needle is carefully inserted into the trigger point of the muscle(s).
5. No medication is injected during the procedure.
6. The needle is removed, and the site is cleaned again.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 20560 services are those experiencing pain, impaired movement, fibromyalgia, or tension headaches that can be treated with needle insertion without injection. The provider must determine that the patient’s condition can be effectively treated using this technique and that the patient does not have any contraindications for the procedure, such as an infection at the site or a bleeding disorder.

5. When to use CPT code 20560

It is appropriate to bill the 20560 CPT code when a provider performs needle insertion without injection into one or two muscles to treat pain, impaired movement, fibromyalgia, or tension headaches. The provider must ensure that the patient meets the qualifying circumstances and that the procedure is medically necessary for the patient’s condition.

6. Documentation requirements

To support a claim for CPT 20560, the following information needs to be documented:

• Patient’s medical history and symptoms
• Physical examination findings
• Diagnosis and rationale for using needle insertion without injection
• Specific muscle(s) treated and the location of the trigger point(s)
• Details of the procedure, including the number of needle insertions and any complications
• Outcome of the treatment and any follow-up care or recommendations

7. Billing guidelines

When billing for CPT code 20560, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT 20560 include:

• Ensure that the patient meets the qualifying circumstances and that the procedure is medically necessary.
• Document all required information to support the claim.
• For needle insertion without injection of 3 or more muscles, report CPT 20561.
• For acupuncture codes, see CPT 97810 to 97814, and for osteopathic manipulative treatment, see CPT 98928, 98929, 98940, 98941.

8. Historical information

CPT 20560 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Similar codes to CPT 20560

Five similar codes to CPT 20560 and how they differentiate from CPT 20560 are:

1. CPT 20561: This code is used for needle insertion without injection into 3 or more muscles, as opposed to 1 or 2 muscles in CPT 20560.
2. CPT 97810: This code refers to acupuncture with a single use of one or more needles, without electrical stimulation, which is different from the needle insertion without injection in CPT 20560.
3. CPT 97811: This code is for acupuncture with a single use of one or more needles, with electrical stimulation, which is not the same as CPT 20560.
4. CPT 98928: This code is for osteopathic manipulative treatment involving 1-2 body regions, which is a different technique than needle insertion without injection in CPT 20560.
5. CPT 98940: This code is for chiropractic manipulative treatment involving 1-2 spinal regions, which is not the same as the needle insertion without injection in CPT 20560.

10. Examples

Here are 10 detailed examples of CPT code 20560 procedures:

1. A patient with chronic neck pain receives needle insertion without injection into the trapezius muscle to alleviate pain.
2. A patient with fibromyalgia undergoes needle insertion without injection into the gluteus medius muscle to improve mobility and reduce pain.
3. A patient with tension headaches receives needle insertion without injection into the suboccipital muscles to relieve headache symptoms.
4. A patient with shoulder pain undergoes needle insertion without injection into the infraspinatus muscle to improve range of motion and decrease pain.
5. A patient with lower back pain receives needle insertion without injection into the erector spinae muscles to alleviate pain and improve function.
6. A patient with hip pain undergoes needle insertion without injection into the piriformis muscle to reduce pain and improve mobility.
7. A patient with elbow pain receives needle insertion without injection into the extensor carpi radialis brevis muscle to alleviate pain and improve function.
8. A patient with knee pain undergoes needle insertion without injection into the vastus medialis muscle to reduce pain and improve mobility.
9. A patient with calf pain receives needle insertion without injection into the gastrocnemius muscle to alleviate pain and improve function.
10. A patient with foot pain undergoes needle insertion without injection into the abductor hallucis muscle to reduce pain and improve mobility.