cpt code 20550

(2022) CPT Code 20550 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 20550 bills for service when the physician administers an injection into the single tendon sheath, or ligament, aponeurosis. The substance injects for Therapeutic purposes, pain management, and treatment of inflammation on the tendon or ligament such as plantar fascia.

20550 CPT Code Description 

A tendon comprises fibrous tissue that joins muscle to bone. It aids in bending or strengthening the joint. The tissues produce fluids that lubricant the joints to move smoothly. Inflammatory conditions release excessive fluid in the synovial joint and cause pain.

The physician injects a therapeutic agent when the patient feels pain in tendons, swollen tendons, and movement issues. It aids as a supportive treatment in conjunction with splinting and Physiotherapies. 

 CPT 20551 reports instead of CPT code 20550 when the physician administers the injection into the tendon insertion site or origin site.

The physician utilizes radiographs and palpation methods to identify the injection site. Radiologic guidance reports separately in conjunction with CPT code 20550.

The physician marks the injection site with the help of radiographs and palpitation. The needle inserts into the targeted tendon to inject the medicine. 

The patient monitors by the physician after withdrawing the needle for reactions to the therapeutic agent. The Drugs are separately reportable with appropriate HCPCS level II J codes. 

CPT code 20550 bills for service when the physician administers an injection into the single tendon sheath, or ligament, aponeurosis such as plantar fascia.

20550 cpt code

CPT Code 20550 Reimbursement

A maximum of five units can be a bill on the same service date of CPT code 20550. In contrast, the three units allow documentation supporting the service’s medical necessity.

The cost and RUVS of CPT code 20550 are $42.02 and 1.21420 when performed in the facility. In contrast, the reimbursement and RUVS of 20550 CPT code are $64.38 and 1.86045 when performed in the non-facility.

CPT Code 20550 Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.  

The following are ICD category 10 Payable Dx codes and report the specified level of dx code accordingly:

D48.1, G56.0X, G57.5X, M20.10, M25.71X, M25.72X, M25.73X, M25.74X, M25.75X, M25.76X, M25.77x, M46.07, M46.09, M46.08, M46.01, M46.02, M46.04, M46.03, M65.11X, M65.12x, M65.13x, M65.14X, M65.15, M65.16x, M65.18x, M65.19x, and M65.31x.  

M65.32x, M65.33x, M65.34x, M65.35x, M65.4, M65.80, M65.81x, M65.82X, M65.83XM M65.84X, M65.85X, M65.86X, M65.87X, M65.88, M65.88, M65.89, M65.9, M66.21X. M66.81X, M67.31X, M67.32X, M67.33X, M67.34X, M70.xxx, M71.xxx, M72.x, M75.xx, M76.xx, and M77.xx.

Injections can administer multiple times for persistent pain if necessary. Documentation should support the necessity of repetition of injections. 

A patient can receive injections one time in one or two weeks and a maximum of two units in the diagnostic phase. 

A patient can receive injections one time in one or two weeks and a maximum of two units in the diagnostic phase. 

If Autologous WBC injection (0481T) performs in combination with 20550 CPT code, report 0481T separately with the appropriate modifier.

Morton’s neuroma (64455, 64632) performs in combination with CPT code 20550. It is appropriate to report 64455 and 64632 separately with the appropriate modifier.

If Platelet-rich plasma injection (0232T) performs in combination with 20550 CPT code, report 0232T separately with the appropriate modifier.

If CPT code 20550 performs in combination with radiologic guidance, report 76942, 77002, and 77021 separately with modifier if appropriate. 

20550 CPT Code Modifiers

The following are the list modifiers when 20550 CPT code bills:

22, 23, 47, 51, 52, 53, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, F1, F2, F3, F4, F5, F6, F7, F8, F9, FA, GA, GC, GK, GR, GU, GY, GZ, KX, PT, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS.

Modifier 76 is applicable with CPT code 20550 when a similar service performs by the Same Physician on the same service date.

Modifier 76 is applicable with 20550 CPT code when a similar service performs by a different Physician on the same service date.

Modifier 59 is applicable with CPT 20550 when a particular service performs by the physician and bundles with another procedure on the same date.  

Modifier X {E, P, S, U} applies instead of Modifier 59 with CPT 20550 when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure.

Modifier 53 reports with CPT code 20550 if unsuccessful triggers injection occurs due to unavoidable circumstances like allergic reactions to the substance.

Modifier 22 applies to 20550 CPT code when services perform longer than usual and take extra resources during the procedure.

Modifier 23 is applicable with CPT 20550 when general or local anesthesia administers by the physician and routinely does not require during the procedure.

Modifier 52 applies when the physician does not complete the injection procedure and service terminates due to unavoidable circumstances.

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT code 20550 must apply the GA modifier to that service.

20550 cpt code description

CPT Code 20550 Examples

The following are the examples when 20550 CPT code bills:

Example 1

A 32 year-0ld female presents to the office with pain in her right hand. She accidentally triggered his finger four days ago. She took medication for pain relief, but it still did not resolve. 

The patient denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms.

The physician ordered a trigger injection for pain.

Office and Lab Procedures: Trigger Finger Injection

Location: injection of tendon sheath Right Hand, Thumb 

Injectate: Lidocaine 1 mL; Celestone; 

Procedure: The physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy. The patient consented to proceed with a cortisone injection into the flexor sheath of the right thumb. The patient tolerated the procedure well.

Example 2

A 44 year-0ld male presents to the office with pain in the right hand and second digit. He accidentally triggered his finger three days ago. She took medication for pain relief, but it still did not resolve. 

The patient denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms.

The physician ordered a trigger injection for pain.

Office and Lab Procedures: Trigger Finger Injection 

Location: injection of tendon sheath Right Hand, Second Digit 

Injectate: Lidocaine 1 mL; Celestone; 

Procedure: The physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy. The patient consented to proceed with a cortisone injection into the flexor sheath of the Right second digit. The patient tolerated the procedure well. 

Trigger Finger Injection 

Location: injection of tendon sheath Right Hand, Fourth DI ;

Procedure: The physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy. The patient consented to proceed with a cortisone injection into the flexor sheath of the Right FOURTH digit. The patient tolerated the procedure well.

Example 3

A 52 year-0ld male presents to the office with pain in his Left hand and Third digit. He accidentally triggered his finger seven days ago. She took medication for pain relief, but it still did not resolve. 

The patient denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms.

The physician ordered a trigger injection for pain.

Treatment Office and Lab Procedures: Trigger Finger Injection 

Location: injection of tendon sheath Left Hand, Third Digi ; 

Injectate: Lidocaine 1 mL; Celestone; 

Procedure: The physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy. The patient consented to proceed with a cortisone injection into the flexor sheath of the Left third digit. The patient tolerated the procedure well.

Trigger Finger Injection Location: injection of tendon sheath Left Hand, Fourth Digit ; 

Injectate: Lidocaine 1 mL; Celestone; 

Procedure: The physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy. The patient consented to proceed with a cortisone injection into the flexor sheath of the Left FOURTH digit.

Example 4

A fifty-two-year-old male presents to the office with pain in the right hand and Third digit. He accidentally triggered his finger seven days ago. She took medication for pain relief, but it still did not resolve. 

The patient denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms. The physician ordered a trigger injection for pain.

Treatment Office and Lab Procedures: Trigger Finger Injection

Location: injection of tendon sheath Left Hand, Third Digit;

Injectate: Lidocaine 1mL; Celestone;

Procedure: After discussion of the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy, the patient consented to proceed with a cortisone injection into the flexor sheath of the left third digit. The patient tolerated the procedure well. 

Trigger Finger Injection

Location: injection of tendon sheath Right Hand, Third Digi ;

Injectate: Lidocaine 1mL; Celestone;

Procedure: The physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy. The patient consented to proceed with a cortisone injection into the flexor sheath of the RIGHT third digit. The patient tolerated the procedure well.

Example 5

A 31-year-old male presents to the office with pain in his right hand. He accidentally triggered his finger two days ago. 

She took medication for pain relief but still not resolved. The patient denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms. The physician ordered a trigger injection for pain.

Treatment Office and Lab Procedures: Trigger Finger Injection

Location: injection of tendon sheath Right Hand, 1st Digit;

Injectate: Lidocaine 1mL; Celestone;

Procedure: The physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy. The patient consented to proceed with a cortisone injection into the flexor sheath of the left third digit. The patient tolerated the procedure well.

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