How To Use CPT Code 20561

CPT code 20561 describes the insertion of a needle, without injection, into three or more muscles by a provider, typically a physical therapist, to help relieve pain. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 20561?

CPT 20561 can be used to describe the insertion of a needle, without injection, into three or more muscles by a provider, usually a physical therapist. This procedure is performed to alleviate pain and improve movement in patients with conditions such as fibromyalgia, tension headaches, and impaired movement. It is important to note that dry needling, as described by CPT 20561, is distinct from traditional Chinese acupuncture.

2. Official Description

The official description of CPT code 20561 is: ‘Needle insertion(s) without injection(s) 3 or more muscles.’

3. Procedure

During the procedure described by CPT 20561, the provider, typically a physical therapist, inserts a fine filiform disposable needle into three or more trigger points in the muscles. No medication is injected during this process. The insertion of the needle aims to alleviate pain, improve movement, and address conditions such as fibromyalgia, tension headaches, and impaired movement. The site is appropriately cleansed before the needle insertion.

4. Qualifying circumstances

CPT 20561 is applicable to patients who require relief from pain and impaired movement in three or more muscles. Conditions such as fibromyalgia, tension headaches, and impaired movement may warrant the use of this procedure. The provider performing the needle insertion should be a qualified professional, typically a physical therapist.

5. When to use CPT code 20561

CPT code 20561 should be used when a provider, usually a physical therapist, performs the needle insertion procedure without injection into three or more muscles. It is important to note that this code is not appropriate for needle insertions into one or two muscles, which should be reported using a different code (e.g., CPT 20560). Additionally, CPT code 20561 should not be used for acupuncture procedures or osteopathic manipulative treatment.

6. Documentation requirements

To support a claim for CPT 20561, the provider must document the following information:

• Patient’s diagnosis and the need for the needle insertion procedure
• Specific muscles targeted and the number of trigger points addressed
• Date and duration of the procedure
• Details of the needle insertion technique used
• Progress made by the patient and any additional sessions scheduled
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 20561, ensure that the provider performing the procedure is a qualified professional, typically a physical therapist. It is important to note that CPT code 20561 should not be reported with acupuncture codes or osteopathic manipulative treatment codes. Additional tips for reporting CPT code 20561 may be available from coding resources.

8. Historical information

CPT code 20561 was added to the Current Procedural Terminology system on January 1, 2020. No updates or changes have been made to the code since its addition.

9. Examples

1. A physical therapist performing needle insertions without injection into three or more muscles to alleviate pain and improve movement in a patient with fibromyalgia.
2. A provider, typically a physical therapist, inserting needles into trigger points in three or more muscles to address tension headaches in a patient.
3. A physical therapist performing needle insertions without injection into multiple muscles to improve movement in a patient with impaired mobility.
4. A provider, usually a physical therapist, performing needle insertions into three or more muscles to alleviate pain in a patient with chronic musculoskeletal conditions.
5. A physical therapist using needle insertions without injection to address pain and impaired movement in multiple muscles of a patient with a sports-related injury.
6. A provider, typically a physical therapist, performing needle insertions into three or more muscles to alleviate pain and improve movement in a patient recovering from surgery.
7. A physical therapist using needle insertions without injection to address pain and impaired movement in a patient with chronic back pain.
8. A provider, usually a physical therapist, performing needle insertions into multiple muscles to alleviate pain and improve movement in a patient with arthritis.
9. A physical therapist using needle insertions without injection to address pain and impaired movement in a patient with a repetitive strain injury.
10. A provider, typically a physical therapist, performing needle insertions into three or more muscles to alleviate pain and improve movement in a patient with myofascial pain syndrome.