Coding for pain management can get confusing. How many injections, the location, and when to use a modifier are all common questions. This article will cover some of the most common injections used in pain management.

Trigger Point Injections

Trigger point injections are reported by how many muscles are treated using an anesthetic, steroid, or other therapeutic substance injected into a single muscle such as tendon sheath, ligament, or ganglion cyst. That being said multiple injections at the same site on the same day are considered one injection and are coded with 1 unit of service (UOS). Do not code the injections or how may injections are done on a single muscle, code the muscle(s). 20552 and 20553 are used to report single or multiple injections on 1-3 or more muscles.

• 20552 - 1 or 2 muscle(s)
• 20553 - 3 or more muscles

Modifier 50 - Bilateral

Bilateral surgical indicator 50 may apply as well, so be sure to code accordingly. Modifier 50 should not be reported with CPT codes 20551, 20552, 20553, or 20612, but may be reported with CPT codes 20550 and 20526 when appropriate.

Modifier 59- Multiple

Multiple surgical rules apply if there are injection(s) done on separate sites during the same encounter and should be reported in a separate line using Modifier 59.

Tendon

20551 should be used when the origin or insertion of a tendon is injected, in contrast to an injection of the tendon sheath, CPT code 20550.

• If image guidance is performed with the injection, it is reported using 76942, 77002, 77021.
• Do not report 20552, 20553 in conjunction with 20560, 20561 for the same muscle(s).
• When the origin or insertion of a tendon is injected, use CPT code 20551.
• 20550 is used for the injection of the tendon sheath.

Reminder: Physicians may only bill for the professional component when imaging is performed in a hospital or non-office facility.

Dry Needling

For dates of service on or after 01/01/2020 use 20560 and 20561 for dry needle insertions but without injection(s). Prior to 01/01/2020 dry needling should be reported with 20999 - Unlisted procedure, musculoskeletal system, general.

• 20560 - 1 or 2 muscle(s)
• 20561 - Needle insertion(s) 3 or more muscles

Acupuncture

Acupuncture is a non-covered service and is reported with CPT codes 97810 – 97814. This range of codes is used to report injection(s) of tendon sheaths, ligaments, ganglion cysts, carpal, and tarsal tunnels. Be sure to read the entire description of the codes to ensure proper usage.

Sacroiliac (SI) Joint Injections

• When an injection is performed using an anesthetic or steroid into the sacroiliac joint, the procedure can be done with or without CT or fluoroscopic imaging.
• If fluoroscopy or CT is used report 27096,
• Without the use of fluoroscopy or CT report 20552.

27096 - Injection procedure for sacroiliac joint (fluoroscopy or CT) including arthrography when performed

G0260 - Injection procedure for sacroiliac joint; provision of anesthetic, steroid, and/or other therapeutic agent, with or without arthrography.

NOTE: One (1) unit of service covers one bilateral injection using modifier 50 or one unilateral injection using RT/LT when reporting 27096.

Other Injections

• 20526 - therapeutic, carpal tunnel
• 20550 - single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")-plantar fasciitis
• 20551 - single tendon origin/insertion
• 20612 - ganglion cyst(s) any location
• 28899 - Unlisted procedure, foot or toes

Medication

The medication used with the injection is reported with a HCPCS Drug code or a revenue code. The claim must indicate the name of the drug and dosage in box 19 of the CMS-1500 or the electronic equivalent, or Field 43 on the UB04 or 8337I. 

The medication is reported on the same claim for the same day of the procedure. The only exception is if the drugs are packaged in ASC payments and should not be reported separately. This would include the following places of service: 19, 21, 22, 23, 61, and 62. Data elements are also required on both paper and electronic submissions, the data elements are the NCD numbers, unit, and quantity

NDC Numbers

An NDC code is 11 digits and describes the manufacturer, the drug, and the package size. 

Units and Quantity

When a HCPCS code or Revenue code is required, you also need to report the Unit of Measurement Qualifier and Unit Quantity. 

For more information on frequency and number of injections or interventions for Medicare beneficiaries see CMS article A52863- Billing and Coding: Pain Management.