(2023) 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.
Description Of The 20550 CPT Code
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.
The official description of CPT code 20550 is: “Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar “fascia”).”
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.
Billing Guidelines
Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.
Injections can administer multiple times for persistent pain if necessary. Documentation should support the necessity of repetition of injections.
A patient can receive injections once in one or two weeks and a maximum of two units in the diagnostic phase.
A patient can receive injections once 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 with 20550 CPT code, report 0232T separately with the appropriate modifier.
If CPT code 20550 performs with radiologic guidance, report 76942, 77002, and 77021 separately with a modifier if appropriate.
Billing Example
The billing examples below are cases when CPT code 20550 should be billed.
A 32-year-old 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 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.
