trigger point injection cpt

Trigger Point Injection (2022) – CPT 20552 & CPT 20553 (Descriptions, Guidelines & Reimbursement)

The trigger point injection CPT codes are 20552 and 20553. CPT 20552 narrates injection(s) administration in a single or multiple trigger point(s) for either 1 or 2 muscles.

The CPT 20553 narrates as the injection(s) is administered for single or multiple trigger point(s) for either three or more muscles. 

Firstly, evaluation is necessary to determine the exact point of pain, the severity, and the cause.

In such a case, Ultrasound and Magnetic Resonance Imaging (MRI), like modalities, diagnose the trigger points. But, again, a trained physician or nurse can perform this task.

Anesthetics such as Lidocaine or Bupivacaine with a small number of corticosteroids are injected at the point of chronic pain. Sanitize the area afterward and monitor the blood oxygen level and blood pressure.

The Trigger Point Injection Procedure

After identifying the trigger point, the clinician holds the overlying skin with the index finger and thumb. Next, a 1.5-inch needle is inserted into the stabilized tissue at around a 30-degree angle to the trigger point. 

The needle is continuously retracted and inserted without completely taking it all out. The needle is to be inserted repeatedly until the tense muscle feels relaxed. This form is the dry needling. 

The injection of lidocaine may reduce post needling soreness. However, the use of corticosteroids such as triamcinolone is highly preferable in this case.

CPT 20552 & CPT 20553 are instant relievers of pain and relax the muscles to allow the patient to perform his routine work efficiently.

Description Of Trigger Point Injection – CPT 20552 & CPT 20553

CPT 20552 and CPT 20553 are for trigger point injections, and they are related to muscular knots, Myofascial pain, and musculoskeletal disorder.

CPT 20552

CPT 20552 code is specific for trigger point injection(s) at multiple points of 1 or 2 muscles, I.e., Active Myofascial Trigger Point at Trapezius and deltoid muscle.

trigger point injection cpt 20522
Description of trigger point injection CPT 20522

CPT 20553

CPT 20553 code is specific for trigger point injection(s) at multiple points of 3 or more muscles, I.e., Active Myofascial Trigger Point at Trapezius and deltoid muscle.

trigger point injection cpt 20523
Description of trigger point injection CPT 20523

How To Use Trigger Point Injection – CPT 20552 & CPT 20553

These musculoskeletal disorders become painful when they are compressed or in the condition of severe strain.

Chronic myofascial pain affects the connective tissues and muscles, and the trigger (sensitive muscle) points become a source of acute pain with muscle contraction.

This is when a physician may recommend trigger point injections and the related medication to treat the chronic pain issue.

The Current Procedural Terminology (CPT) codes, i.e., CPT 20552 and CPT 20553, are common medical procedural codes that range over the pain management of the myofascial pain syndrome (MPS) by trigger point injection therapy.

Myofascial trigger points are the knots formed in the taut band of skeletal muscle, characterized by palpable regions of stiffness and tenderness. 

Trigger points may gradually develop over a trauma or microtrauma, leading to muscle chord tension.

The development of trigger points at large upper back muscles (Trapezius), neck, shoulder, or temporomandibular joint is most common among MPS patients (Myofascial Pain Syndrome). 

Patients can have multiple trigger points in their overall musculoskeletal system (MSS). CPT 20552 and CPT 20553 ensure the relaxation of the targeted muscle to give the time for recovery.

There is a sub-classification of myofascial trigger points (MTrPs) from a manual of Travell and Simons; Active and Latent MTrPs.

Active MTrPs are associated with the chronic pain of the muscle; sustained muscle contraction can also bring about other conditions like hypoxia or ischemia.

Latent MTrPs are associated with pain upon manual palpation and can be treated with CPT 20552 procedure.

Trigger point injections temporarily relax the taut muscles, which replenishes the supply of ATP to actin-myosin chains causing stretching of muscle fiber removing the lumen of metabolic wastes.

Patients may opt for CPT 20552 as their initial treatment merely for their joint impairment or incapability to stretch the muscle, which has to be avoided unless the conservative and noninvasive methods rule out. 

Evaluation of the site of pain and severity of pain is diagnosed either by Ultrasonic guided (CPT 76942) or Magnetic Resonance Imaging (MRI) (CPT 77021).

Conservative treatment can be opted by the patient, including hot and cold physical therapies and deep fascia massage; several exercises are recommended. Medications include analgesics and anti-depressants, which have proven effective for chronic pain.

Billing Guidelines For Trigger Point Injection CPT Codes

The billing Method by the US Medicare Official organization is prefixed as follows.

The billing depends on DOS (Date of Service), POS (Place of Service), and the other performed services. 

This billing method is solely based on US Medicare’s officially announced services charges.

A hospital has an outpatient department that treats the outpatients who do not require a bed or an overnight stay and care. However, outpatient departments perform a broad range of services, including diagnostic tests and minor surgical procedures.

Ambulatory Surgery Centers (ASCs) are cost-effective surgical centers dealing with pain and diagnostics. Overnight stay is not required, which saves the cost of hospitalization.

Surgeries performed here are less complicated but still require a surgeon and a proper center to perform the procedure.

Aetna’s Medical Policy

The physician must not necessarily repeat the injections more often than every seven days. Trigger injections that a physician can order must be limited to four per year.

This number of injections is enough to diagnose the patient correctly and get the patient’s pain threshold to provide the patient with relief from the pain. 

If the trigger injections are ordered more than 4 per year, then it does not show medical necessity in any way.

The injections used are steroids in nature, and they may have a longer duration of action. The corticosteroids used for pain management are more often prescribed, usually with the delays of months.

The primary code has to be the surgical procedure code (SPC) which comes before the guidance code that can be CPT 76942 if the Ultrasound Guidance needle placement method is used.

Make sure once committal to writing for trigger purpose injections that documentation support proof of conservative medical aid, documentation supports the positioning and range of injections and range of muscles. 

Check that you refer to the patient’s medical policy for details on limitations of frequency together with the identification codes that support medical necessity for the trigger purpose injection(s).

Centers for Medicare & Medicaid Services (CMS) do not have a National Coverage Determination (NCD), but many of the CMS Medicare contractors have LCDs (Local Coverage Determination).

Other private insurance companies also have proper instructions for the usage of trigger point injections. 

It is essential to review the patient’s payer policies when performing these services as it is the coding, documentation, and clinical indicators that pay in the end.

More than four (4) trigger point injections will not be covered in a year.

If there is a condition in which the patient must have additional procedures than four per year, it should be supported by the medical necessity. 

It should be accompanied along with thorough documentation. According to the guidelines narrated by AMA, it is prohibited to use either CPT 20552 or CPT 20553 within a single year.

CPT codes for the trigger point injections are 20552 and 20553, and the specifications of these two codes include the following:

CPT 20552 injections may be used as single or multiple trigger points, and the incision may be applied to one or two muscles accordingly.

CPT 20553 injections may be used as single or multiple trigger points, and the incision may be applied to three or more muscles as per the requirement or the demand of the situation.

In addition to these services, local anesthesia is required to ensure that the patient gets proper treatment and gets relieved to the optimum limit from this treatment. 

Local anesthesia does not have to be billed as it is already included in these services.

Trigger point injection is employed to bring calmness to muscle pain and relieve legs, arms, neck, and lower back-related body muscles.

Some other pains that this trigger point injection relieves include fibromyalgia, myofascial pain, and tension headache.

The task of the injection is to untie the trigger point knots from muscles to make sure that the muscles get relieved and the knots get their respective treatment.

Reimbursement For Trigger Point Injections CPT 20552 & CPT 20553

The trigger point injection cost at MDsave may range from US$363 to US$600. Anyhow, the cost may be lower if the injections are bought upfront through this service.

In addition, the cost can be reduced for the people who have healthcare coverage (insurance).

The coder must keep in mind the variants related to the CPT codes mentioned above to go for the trigger point injections.

Suppose the correct codes are applied for reimbursement purposes. In that case, everything will be fine in this connection, and the physician will get their compensation as per the desired billing without passing through the auditing process.

CPT 20552

Ambulatory Surgery Centre charges $67, including doctor and facility fees per procedure and aftercare.

A patient only has to pay $12, while US Medicare pays the other amount out of this. The patient can be verily benefitted depending on the possession of Medicare Advantage plan or supplemental insurance Policy.

While Hospital Outpatient departments charge an average total of $299 per procedure, this patient pays about $59 while US Medicare reimburses the remaining amount.

Fares can vary upon possession of a Medicare Advantage Plan or Supplemental Insurance Policy.

CPT 20553

Ambulatory Surgery Centre charges a total of $77, including doctor’s fee and Facility fee per procedure and aftercare. Out of this, a patient only has to pay $14 while US Medicare pays another amount.

The patient can be verily benefitted depending on the possession of Medicare Advantage plan or supplemental insurance Policy.

While Hospital Outpatient departments charge an average total of $304 per procedure, the patient pays about $60 while US Medicare reimburses another amount. The fares can vary upon possession of a Medicare Advantage Plan or Supplemental Insurance Policy.

The costs provided are national averages and cannot be considered a final utmost word.

The physician’s fee is not included in this amount. More than one procedure may be employed for treatment, and charges may vary following that.

Your supplemental insurance policy may cover your procedural costs. Professional medical advice, diagnosis, or treatment is still advised, and this should be considered the only form of reliable information.

Modifiers For CPT 20552 & CPT 20553

CPT 20552 and CPT 20553 do not rely on modifiers. Basic modifiers like LT or RT are invalid regarding 20552 as muscles exist in the body unilaterally rather than just in paired locations.

For paired muscles, modifiers like LT and RT can be used.

Examples For Trigger Point Injection CPT

Some billable services along with the “trigger point injection” are as follows.

Example 1

The use of ultrasonic guidance and supervision by images, with CPT 76942, to place the needle for biopsy, injection, aspiration, and localization may be employed and billed according to the charges set forth by the American medical association.

Example 2

The use of Fluoroscopic guidance, CPT 77002, to place the needle for biopsy, injection, aspiration, and localisation may be employed and billed according to the charges set forth by the American medical association.

Therefore this service should be listed separately by the coder.

Example 3

The use of Magnetic resonance guidance, CPT 77002, to place the needle for biopsy, injection, aspiration, and localization may be employed and billed according to the charges set forth by the American medical association, and this service is used for radiological supervision.

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