CPT code 20610 – 20605, 20600, 20611 – ICD – Billing Guide (2022)

Procedure code and Decription


20610 – Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance – average fee amount- $55 – $75


20611 Arthrocentesis, aspiration and /or injection, major joint or bursa (eg. shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting for SI joint injections.


20605 – Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance – average fee amount- $40 – $60

20600 Arthrocentesis, aspiration and/or injection;small joint or bursa (eg, fingers, toes)



Indications

This procedure may be for diagnostic and/or therapeutic purposes.

A diagnostic procedure for evaluation of joint pain and/or swelling to help establish the etiology (i.e., septic arthritis, gout, rheumatoid arthritis, injury, etc.)

Periodic treatment of unremitting joint pain that has not responded to alternative or conservative measures including (at minimum) an adequate trial of non-steroidal anti-inflammatory medication or non-narcotic analgesics.

Treatment of acute inflammatory conditions when intralesional therapy is the treatment of choice.

Treatment of monoarticular conditions where the benefits of periodic steroid injection exceed the risk of systemic therapy.

Medicare Recommendations for Knee Injection

Purpose: To establish uniform criteria for billing knee injections, viscosupplementation injections of the knee and ultrasound guidance.

Applies To: Procedure code© Procedure Codes 20610 Arthrocentesis, aspiration and/or injections; major joint or bursa 76942 Ultrasonic guidance for needle placement, imaging supervision and interpretation, and applicable HCPCS Codes; J7321 (Hyalgan or Supratz), J7323 (Euflexxa), J7324 (Orthovisc), J7325 (Synvisc or SynviscOne) and J7326 (Gel-One)

The aspiration and/or injection procedure code may be billed in addition to the drug. Indicate which knee was injected by using the RT (right) or LT (left) modifier (FAO-10 electronically) on the injection procedure (Procedure code 20610). Place the Procedure code 20610 in item 24D. If the drug was administered bilaterally, a -50 modifier should be used with 20610.


Billing Example


Scenario 1

• Injection performed on same day as an established patient visit for a new complaint – Modifier 25 is appended to E & M code


Date of Service Treatment CPT/Modifier


8/25/2015 Arthrocentesis, without ultrasound guidance 20610
8/25/2015 E & M visit 99213 25

Scenario 2

• Patient is told to return for another injection for same condition – Since reason for visit has already been established, E/M is bundled into procedure

• Do not bill separately

Date of Service Treatment CPT/Modifier

8/25/2015 Arthrocentesis, without ultrasound guidance 20610

Scenario 3

• Two injections are administered on same joint – Only one 20610 should be billed • Example: 2 injections to right shoulder

Date of Service Treatment CPT/Modifier

8/25/2015 Arthrocentesis, without ultrasound guidance 20610

Effective January 1, 2015 three new codes are used to report arthrocentesis services with ultrasound guidance:

-CPT code 20604 – Arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes), with ultrasound guidance, with permanent recording and reporting -CPT code 20606 – Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa) with ultrasound guidance, with permanent recording and reporting

– CPT code 20611 – Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g. shoulder, hip, kneejoint, subacromial bursa) with ultrasound guidance, with permanent recording and reporting

This means is that CPT code 76942 – Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation is NO LONGER reported with this series of CPT codes and codes 20600, 20605 and 20610 now have the language “without ultrasound guidance”. Please note the CPT code 76942 is still an active code and could and should be reported with other aspiration or injection services as appropriate.


Joint Injections

** Use code 20600 for an Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes).

** Use code 20605 for an Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa).

** Use code 20610 for an Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa). Use this code if an SI Joint Injection is done without any imaging (instead of 27096 or G0260).

Correspondence Language Policy/Example Number 10.20000 – Standards of medical/surgical practice

For example, CPT code 25115 describes a radical excision of a bursa or synovia of the wrist. It is standard surgical practice to preserve neurologic function by isolating and freeing nerves as necessary. A neuroplasty (e.g. CPT code 64719) should not be reported separately for this process. Therefore, CPT code 64719 is bundled into CPT code 25115.



Correspondence Language Policy/Example Number 11.20000 – Anesthesia service included in surgical procedure

For example, when a small joint or bursa arthrocentesis, aspiration and/or injection (CPT code 20600) is performed, anesthesia may be provided by the surgeon using a digital nerve block (CPT code 64450). Because this type of anesthesia provided by the surgeon performing the procedure is not separately payable, CPT code 64450 is bundled into CPT code 20600 when the same physician performs both procedures.

Joint Injection Codes

• Three new joint injection codes (20604, 20606, and 20611) include the use of ultrasound guidance.

• The new codes (20604, 20606, and 20611) include the descriptor, “with ultrasound guidance, with permanent recording and reporting.” These new codes specifically address ultrasound guidance and require that the report be included in the patient’s permanent record. Coders should check the guidelines for reporting 20600, 20605 or 20610 with fluoroscopic, computed tomography, or magnetic resonance imaging guidance.

• As a result, descriptors for CPT codes 20600, 20605, and 20610 have changed.

• Descriptors for CPT codes 20600, 20605, and 20610 now include the statement “without ultrasound guidance.”

(Video) Target Coding Video Billing & Coding for Knee Injections, Trigger Point Injections, Knee Braces

• CPT code 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation, may not be reported with any joint injection codes (20600, 20604, 20605, 20606, 20610 or 20611).

Knee Injection CPT CODE 20610, 20611 – Description and Guidelines

Billing Guide for reporting HYALGAN – Administration

CPT

To report the physician administration of HYALGAN, the following CPT code may be appropriate when HYALGAN is administered in the physician office setting:

CPT Description

20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), without ultrasound guidance

20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting

CPT codes should be reported in Box 24D of the CMS-1500 claim form as well. In certain instances, payers may require modifier “-RT” (right side) or “-LT” (left side) to be documented after CPT code 20610, to specify the knee in which HYALGAN was administered. For bilateral administration of HYALGAN, some payers may require modifier “-50” (bilateral procedure) to be documented after CPT code 20610. In addition payers may require EJ modifier, usually following the first injection, to indicate subsequent injections in a series of injections. A series of injections for each joint and each treatment, left knee is a separate series from the right knee.

HCPCS Code Description

J7321 Hyaluronan or derivative, HYALGAN or SUPARTZ, for intra-articular injection, per dose

2016 First-Quarter Medicare Allowed Payment* $88.16

CPT Description

20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), without ultrasound guidance

20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting

2016 Medicare National Average Payment (Non Facility) $61.23 $93.09

In general, Medicare pays 80% of the allowed amount of the drug/product and service. Medicare beneficiaries are responsible for 20% of the allowed amount of the drug/product and service once a deductible has been met. If a Medicare beneficiary has a source of secondary coverage, that insurance may be used toward this cost-sharing requirement.

*This allowed payment is subject to change throughout 2016.

CPT

To report the physician administration of HYALGAN, the following CPT code may be appropriate when HYALGAN is administered in the hospital outpatient setting:

CPT Description

20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), without ultrasound guidance

20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting CPT codes should be reported in Box 44 of the CMS-1450/UB-04 claim form as well.

MODIFIERS: In certain instances, payers may require modifier “-RT” (right side) or “-LT” (left side) to be documented after CPT code 20610/20611, to specify which knee HYALGAN was administered to. For bilateral administration of HYALGAN, some payers may require modifier “-50” (bilateral procedure) to be documented after CPT code 20610/20611. Use “EJ” modifier on drug codes to indicate subsequent injections of a series. Do not use this modifier for the first injection of each series of injections. A series is defined as the set of injections for each joint and each treatment. Injection of the left knee is a separate series from injection of the right knee.

Revenue Codes

When prescribing HYALGAN therapy within the hospital outpatient setting, revenue codes may also be used to report services and supplies that are utilized during treatment. Revenue Code Description
0636 Drugs requiring detailed coding
0510 Clinic, general

APC Description

0204 Level I Nerve Injections
0873 Hyalgan inj per dose
2016 First Quarter Medicare

Allowed Payment* $233.76 $88.12 Physician reimbursement in the hospital outpatient setting:

CPT 20610 20611 Description

Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), without ultrasound guidance

Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting 2016 Medicare

National Average Payment $61.23 $93.09

In general, Medicare pays 80% of the allowed amount of the drug/product and service. Medicare beneficiaries are responsible for 20% of the allowed amount of the drug/product and service once a deductible has been met. If a Medicare beneficiary has a source of secondary coverage, that insurance may be used toward this cost-sharing requirement

Indications and Limitations of Coverage and/or Medical Necessity


Indications

This procedure may be for diagnostic and/or therapeutic purposes.

A diagnostic procedure for evaluation of joint pain and/or swelling to help establish the etiology (i.e., septic arthritis, gout, rheumatoid arthritis, injury, etc.)

Periodic treatment of unremitting joint pain that has not responded to alternative or conservative measures including (at minimum) an adequate trial of non-steroidal anti-inflammatory medication or non-narcotic analgesics.

Treatment of acute inflammatory conditions when intralesional therapy is the treatment of choice.

Treatment of monoarticular conditions where the benefits of periodic steroid injection exceed the risk of systemic therapy.

Arthrocentesis is the puncture of a joint space with a needle in order to aspirate (withdraw) accumulated fluid from the joint and/or to inject an anesthetic agent and/or a steroid agent into the joint to relieve inflammation and pain.

Arthrocentesis, aspiration and/or injection (20600, 20605, 20610) is a covered service under the Medicare program when performed by a physician/ non-physician practitioner( NPP) in compliance with state laws, within their scope of practice/training and within the accepted standards of medical practice.

The following Indications and Limitations statement applies to Arthrocentesis, Small Joint, Intermediate Joint, and Major Joint.

Arthrocentesis, injection or aspiration would be medically necessary when fluid (effusion) or inflammation is present in a joint or bursa. Inflammation would be characterized by the presence of warmth, pain and/or swelling.

Arthrocentesis, aspiration, or injection of a joint or bursa would be considered medically necessary when (see ICD-10 Codes that Support Medical Necessity):

there is localized pain at a joint or over the site of a bursa. Pain over the bursa may be increased when muscles and tendons over the bursa are moved against resistance. Joint pain may be increased at night and on motion,

there is pain, swelling, warmth and/or redness at the joint site or over the bursa if the bursa is superficial,

there is an accumulation of fluid. Repeat aspiration may be warranted based on the clinical situation when there is a re-accumulation of fluid,

necessity for fluid aspiration for biochemical, or cellular diagnosis and/or culture, and

pyarthrosis is present and repeat aspirations are necessary (sometimes at intervals of 2-6 hours) for decompressing a joint and instilling antibiotics.

CMS Coverage Policy

Title XVIII of the Social Security Act, Section 1833 (e). This section states that no payment shall be made to any provider for any claims that lack the necessary information to process the claim.

Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be reasonable and medically necessary, i.e., reasonable and necessary are those tests used in the diagnosis and management of illness or injury or to improve the function of a malformed body part.

Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Limitations:

1. Injection or aspiration of soft tissue structures other than true joints, bursae or ganglion cysts are not payable under CPT codes 20600-20612 and should not be billed using these codes.

2. Injection/aspiration of a joint, bursa or cyst during any patient encounter is limited to one service per joint, bursa or cyst. For example, if a joint is aspirated and injected during the same encounter, only one procedure should be billed and it is coded as one (1) unit, regardless of the number of medications given, or the number of times the joint space is entered. The anatomic ICD-9 CM code should match the size of the joint injected.

3. Since there are no true bursae in the lesser toes and it is virtually impossible to inject intra-articularly into the distal interphalangeal joints of the lesser toes, CPT 20600 is not reimbursable for these services. Medical records must document the exact toe, joint or bursa injected in all cases.

4. The term “adventitious bursa” refers to the local development of inflammatory tissue in response to chronic pressure or irritation. This part of the natural process of corn and callus formation. Medicare statutorily excludes the direct treatment of corns and calluses. Since adventitious bursae of the toes are directly related to corn formation, and since anesthetic/corticosteroid injection of these structures provides only temporary and limited relief from inflammatory pain, coverage is limited and repeat frequent injections are not considered reasonable and necessary except as described below. Definitive treatment of chronic pain due to corns and calluses requires removal of the inciting pressure/irritation, such as by shoe modification and/or surgical intervention.

Exception: For the uncommon situation where inflamed soft tissue (adventitious bursae) under or around digital corns, particularly interdigital corns, becomes so painful as to require immediate intervention by local anesthetic/corticosteroid injection, payment may be made up to two such injections per patient per year. These injections should be coded using CPT 20600 and ICD-9 CM 726.79 – toe bursitis, which is reserved for this circumstance, and appropriate toe modifiers and medication codes (J codes).

5. Physical therapy treatment/modalities performed in conjunction with arthrocentesis/injection, at the same patient encounter, and for the same pathophysiological condition are not considered reasonable and necessary and will not be reimbursed.

6. Repeated intra-articular injections of corticosteroids have been shown to cause joint destruction and when given in juxtaposition to tendons, to cause tendon rupture. With the exception of joint viscosupplementation with hyaluronase polymers such as Synvisc (which may initially require 3 weekly injections), or Hyalgan (which may initially require up to 5 weekly injections), more than two therapeutic injections of the same medication to a joint, bursa or ganglion cyst is indicated only if there has been a significant documented clinical response to prior similar injections. Claims for multiple therapeutic injections of the same medication into a joint, bursa or ganglion cyst will be denied as not reasonable and necessary if the medical record fails to indicate that there has been a significant initial or ongoing clinical response.

Joint Injections

Use code 20610 for an Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa). Use this code if an SI Joint Injection is done without any imaging (instead of 27096 or G0260)

* Use code 20600 for an Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes).

* Use code 20605 for an Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa).

* Use code 20610 for an Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa). Use this code if an SI Joint Injection is done without any imaging (instead of 27096 or G0260)

Joint Manipulations

Procedure code guidelines are that if a surgical arthroscopy is performed on the same joint when a Joint Manipulation and/or Joint Injection are performed in the same case, only the scope procedure is billable.

* Shoulder Joint Manipulation code is 23700. This procedure may be performed in the same case with a Joint Injection (code 20610) on the same joint. This procedure is usually performed for Adhesive Capsulitis, for post-shoulder replacement stiffness and for “frozen shoulder” conditions.

* Knee Joint Manipulations procedures (code 27570) should only be billed when it is the only procedure performed or is performed in the same case with a Joint Injection (code 20610), both procedures are billable, unless Unbundled.

Code 27275 for the Manipulation of the Hip Joint under general anesthesia, which may be performed in the same case with a Hip Joint Injection (code 20610).

The G-code and 27096 codes are for use billing SI Joint Injections performed with radiologic guidance. If the SI Joint Injection is performed without the use of radiologic guidance, neither the G-code nor the 27096 should be billed. SI Joint Injections performed without the use of radiologic guidance should be billed using the 20610 code for an Injection into a Major Joint (which reimbursed at a low rate by Medicare). The 20610 code would be used by both the physician and the ASC

facility.

Arthrocentesis

20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting (Do not report 20610, 20611 in conjunction with 27370, 76942) (If fluoroscopic, CT, or MRI guidance is performed, see 77002, 77012, 77021)

Three new codes (20604, 20606 and 20611) were proposed to describe ultrasound imaging guidance as an inclusive component of arthrocentesis, aspiration and/or injection of a joint or bursa. Fluoroscopicguided arthrocentesis will remain component coded. Revisions were made to 20605 and 20610 to denote the procedures are performed without ultrasound guidance.

Policy:

Knee injections with corticosteroids may be performed as deemed medically necessary by the physician.

Knee injections for viscosupplementation will be performed at the physician’s discretion in accordance with medical necessity standards supporting osteoarthritis of the affected joint under the following conditions:

– There is radiological evidence to support the diagnosis of osteoarthritis; and

– There is adequate documentation that simple pharmacologic therapy (e.g. aspirin), or exercise and physical therapy have been tried and the patient failed to respond satisfactorily Additional repeat viscosupplementation treatments are considered medically necessary and can be billed for patients being treated for osteoarthritis of the knee, who meet both of the following criteria:

– Significant improvement in knee pain and known improvement in functional capacity resulted from previous series of injections which has been documented in the record; and

– At least six (6) months have lapsed since the prior series of injections.

Ultrasound guidance for knee injections should not be a routine policy and can only be billed when at least one of the following medical necessity requirements has been met and thoroughly documented:

– History of severe trauma which would derange the normal architecture of the joint

– Erosive systemic arthritis (rheumatoid disease) or other systemic disease (lupus, gout, etc.).

– Failure of the initial attempt of a knee joint injection

– Size of the knee due to morbid obesity (BMI = 40) or other disease process

– Aspiration of a Baker’s cyst

Billing points:

– If aspiration and injection performed in same session, bill only one unit 20610.

– Append appropriate site modifier to code 20610 (RT/LT) unilateral or modifier (50) bilateral.

– Drug codes must be reported on separate line for each site being injected with a modifier (RT or LT).

– Evaluation and management codes will not be routinely billed with joint injections. When a separately identifiable service has been provided and thoroughly documented, they may be billed with modifier 25

Example Scenario Correct Code(s) Coding Rationale

1 An established patient is seen for periodic follow-up for hypertension and diabetes.

During the visit, the patient asked the physician to address right knee pain which developed after recent yard work. The physician performed a problem-focused history and exam of the patient’s hypertension and diabetes, and adjusted medications.Then the physician evaluated the knee and performs an arthrocentesis.

99212-25 20610

The evaluation of the knee problem is included in the arthrocentesis reimbursement. The presenting problem for the visit was other than the knee problem. A separate evaluation of the hypertension and diabetes was performed (Grider4 ) (and would havebeen performed if the knee problem did not exist), making the use of modifier 25 appropriate.

An established patient returns to the orthopedic physician with escalating right knee pain 6 months post a series of Hyaluronan injections. After evaluating the knee and the patient’s medical suitability for the procedure (meds, vitals, etc.), the physician determines a second series of hyaluronan injections is needed and performs the first of three intraarticular injections.

20610

It would not be appropriate to bill the E/M visit, because the focus of the visit is related to the knee pain, which precipitated the injection procedure. The evaluation of the knee problem and the patient’s medical suitability for the procedure is included in the injection procedure reimbursement

New 2015Procedure code™ Changes for Injection Codes

As of January 1, 2015, there is a coding change to the arthrocentesis injection codes (20600 – 20611). The codes are now separated to reflect an injection/aspiration with or without ultrasound guidance. The coding corner below will demonstrate an example of this change.

Procedure code 20611 is one of the new code changes in the 2015 Procedure code ™ and there are a total of six changes to this group of codes (20600 -20611).

20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., Temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance

20606 with ultrasound guidance, with permanent recording and reporting (Do not report 20605, 20606 in conjunction with 76942)

2015 Arthrocentesis Injection coding updates

Starting January 1, 2015 all providers will need to properly report Arthrocentesis procedures dependent if the procedure was performed with or without ultrasound guidance.

Without Ultrasound Guidance:

Starting January 1, 2015, Procedure codes 20600, 20605, or 20610 have been revised to describe Arthrocentesis procedures performed without ultrasound guidance.

v20600: Arthrocentesis, aspiration and /or injection, small joint or bursa (eg, fingers; toes); without ultrasound guidance, with permanent recording and reporting.

v20605: Arthrocentesis, aspiration and /or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, writs, elbow or ankle, olecranon bursa;); without ultrasound guidance, with permanent recording and reporting.

v20610: Arthrocentesis, aspiration and /or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance, with permanent recording and reporting.

The G-code and 27096 codes are for use billing SI Joint Injections performed with radiologic guidance. If the SI Joint Injection is performed without the use of radiologic guidance, neither the G-code nor the 27096 should be billed. SI Joint Injections performed without the use of radiologic guidance should be billed using the 20610 code for an Injection into a Major Joint (which reimbursed at a low rate by Medicare). The 20610 code would be used by both the physician and the ASC
facility.

Steps for proper coding:

Determine the size of the joint.

Review the description to determine if imaging is used.

Report 20604, 20606, or 20611 if performed with ultrasound guidance

If fluoroscopic, CT, or MRI guidance is used report 20600, 20605, 20610 for the surgical procedure and see 77002, 77012, and 77021 to report imagining guidance separately.

As always, my staff will be available to assist you with any questions are concerns you may have.

GeneralGuidelines

1. Procedure code 27096 is to be used only with imaging confirmation of intra-articular needle positioning.

2. If the muscles surrounding the sacroiliac joint are injected in lieu of the joint, then a trigger point injection should be reported and not a sacroiliac joint injection.

3. It is not appropriate to use CPT code 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa); without ultrasound guidance or CPT code 2

4. Procedure code 27096 represents a unilateral procedure. If bilateral SI joint arthrography is performed, 27096 should be reported with a –50 modifier.

5. CPT code G0260 should be billed by facilities paid by OPPS.

6. Use CPT code 64999 (Unlisted procedure, nervous system) for pulsed radiofrequency and the denervation procedures of the sacro-iliac joint/nerves. Pulsed radiofrequency for denervation is considered investigational and therefore, not medically necessary. Sacro-iliac joint/nerve denervation procedures are also considered investigational and not medically necessary.



HCPCS/CPT Code Outpatient Hospital Services MUE Values


20605 2
20606 2
20610 2
20611 2

* Until September 30th 2017 Medicare covers a maximum of 4 units for the above codes.

* Effective October 1st 2017 only 2 units is applicable for the above codes.



Billing Guide for HYALGAN – CPT 20610

CPT To report the physician administration of HYALGAN, the following CPT code may be appropriate when HYALGAN is administered in the physician office setting:

CPT Description

20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), without ultrasound guidance 20611

Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting

CPT codes should be reported in Box 24D of the CMS-1500 claim form as well. In certain instances, payers may require modifier “-RT” (right side) or “-LT” (left side) to be documented after CPT code 20610, to specify the knee in which HYALGAN was administered. For bilateral administration of HYALGAN, some payers may require modifier “-50” (bilateral procedure) to be documented after CPT code 20610. In addition payers may require EJ modifier, usually following the first injection, to indicate subsequent injections in a series of injections. A series of injections for each joint and each treatment, left knee is a separate series from the right knee.

Medicare

When HYALGAN is provided in the physician office setting, both the product and the services associated with its administration may be reimbursed by Medicare. The payment methodology for HYALGAN is expected to be based on its Average Sales Price (ASP) plus 6%. Please note that Medicare’s drug and product payment rates change on a quarterly basis. In addition, services that are associated with HYALGAN administration would be reimbursed based on the Medicare Physician Fee Schedule (MPFS). While payment rates for drugs/products and administration services change, the following provides an example of Medicare’s reimbursement for HYALGAN and its administration in first-quarter 2016 when therapy is provided in the physician setting.

HCPCS Code Description J7321 Hyaluronan or derivative, HYALGAN or SUPARTZ, for intra-articular injection, per dose2016 First-Quarter Medicare Allowed Payment* $88.16

CPT Description

20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), without ultrasound guidance

20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting 2016 Medicare National Average Payment (Non Facility) $61.23 $93.09

In general, Medicare pays 80% of the allowed amount of the drug/product and service. Medicare beneficiaries are responsible for 20% of the allowed amount of the drug/product and service once a deductible has been met. If a Medicare beneficiary has a source of secondary coverage, that insurance may be used toward this cost-sharing requirement.



MODIFIERS: In certain instances, payers may require modifier “-RT” (right side) or “-LT” (left side) to be documented after CPT code 20610/20611, to specify which knee HYALGAN was administered to. For bilateral administration of HYALGAN, some payers may require modifier “-50” (bilateral procedure) to be documented after CPT code 20610/20611. Use “EJ” modifier on drug codes to indicate subsequent injections of a series. Do not use this modifier for the first injection of each series of injections. A series is defined as the set of injections for each joint and each treatment. Injection of the left knee is a separate series from injection of the right knee.

While the payment rates for drugs/products and administration services change, the following provides an example of Medicare’s reimbursement for HYALGAN and its administration in first quarter 2016 when therapy is provided in the hospital outpatient setting.

RationaleProcedure codeEdit Guide

Anthem Central Region bundles 20550, 20551, 20552 and 20553 as incidental to 20600, 20600-50, 20600-LT, 20600-RT, 20600-FA-F9, 20600-TA-T9, 20605, 20605-50, 20605-LT, 20605-RT, 20610, 20610-50, 20610-LT and 20610-RT. Based on the National Correct Coding Initiative Edits, cods 20550, 20551, 20552 and 20553 are listed as component codes to codes 20600, 20605 and 20610. Therefore, if 20550, 20551, 20552 or 20553 is submitted with 20600, 20600-50, 20600-LT, 20600-RT, 20600-FAF9, 20600-TA-T9, 20605, 20605-50, 20605-LT, 20605-RT, 20610, 20610-50, 20610-LT and 20610- RT— only 20600, 20600-50, 20600-LT, 20600-RT, 20600-FA-F9, 20600-TA-T9, 20605, 20605-50, 20605-LT, 20605-RT, 20610, 20610-50, 20610-LT and 20610-RT reimburses.

Anthem Central Region does not bundle 20550-59, 20551-59, 20552-59 and 20553-59 with 20600, 20600-LT, 20600-RT, 20600-FA-F9, 20600-TA-T9, 20605, 20605-LT, 20605-RT, 20610, 20610-LT and 20610-RT. If 20550, 20551, 20552 or 20553 is performed on one anatomical site and 20600, 20600-LT, 20600-RT, 20600-FA-F9, 20600-TA-T9, 20605, 20605-LT, 20605-RT, 20610, 20610-LT
and 20610-RT is performed on a separate/different anatomical site, append modifier 59 to 20550, 20551, 20552 or 20553 and both services reimburse separately.

The initial office visit to initiate hyaluronan therapy may be billed using an evaluation and management Procedure code;
however, the use of both Procedure code 20610 and an evaluation and management Procedure code during subsequent
visits for the sole purpose of hyaluronan injections is not routinely warranted.

ICD-10 CODE DESCRIPTION

A18.02 Tuberculous arthritis of other joints
A52.16 Charcot’s arthropathy (tabetic)
E08.610 Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy
E09.610 Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy
E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy
E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy
E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy
I00 Rheumatic fever without heart involvement
L40.50 Arthropathic psoriasis, unspecified
L40.54 – L40.59 – Opens in a new window Psoriatic juvenile arthropathy – Other psoriatic arthropathy
M00.011 – M00.019 – Opens in a new window Staphylococcal arthritis, right shoulder – Staphylococcal arthritis, unspecified shoulder
M00.051 – M00.069 – Opens in a new window Staphylococcal arthritis, right hip – Staphylococcal arthritis, unspecified knee
M00.111 – M00.119 – Opens in a new window Pneumococcal arthritis, right shoulder – Pneumococcal arthritis, unspecified shoulder
M00.151 – M00.169 – Opens in a new window Pneumococcal arthritis, right hip – Pneumococcal arthritis, unspecified knee
M00.211 – M00.219 – Opens in a new window Other streptococcal arthritis, right shoulder – Other streptococcal arthritis, unspecified shoulder
M00.251 – M00.269 – Opens in a new window Other streptococcal arthritis, right hip – Other streptococcal arthritis, unspecified knee
M00.811 – M00.819 – Opens in a new window Arthritis due to other bacteria, right shoulder – Arthritis due to other bacteria, unspecified shoulder
M00.851 – M00.869 – Opens in a new window Arthritis due to other bacteria, right hip – Arthritis due to other bacteria, unspecified knee
M01.X11 – M01.X19 – Opens in a new window Direct infection of right shoulder in infectious and parasitic diseases classified elsewhere – Direct infection of unspecified shoulder in infectious and parasitic diseases classified elsewhere
M01.X51 – M01.X69 – Opens in a new window Direct infection of right hip in infectious and parasitic diseases classified elsewhere – Direct infection of unspecified knee in infectious and parasitic diseases classified elsewhere
M02.011 – M02.019 – Opens in a new window Arthropathy following intestinal bypass, right shoulder – Arthropathy following intestinal bypass, unspecified shoulder
M02.051 – M02.069 – Opens in a new window Arthropathy following intestinal bypass, right hip – Arthropathy following intestinal bypass, unspecified knee
M02.09 Arthropathy following intestinal bypass, multiple sites
M02.111 – M02.119 – Opens in a new window Postdysenteric arthropathy, right shoulder – Postdysenteric arthropathy, unspecified shoulder
M02.151 – M02.169 – Opens in a new window Postdysenteric arthropathy, right hip – Postdysenteric arthropathy, unspecified knee
M02.211 – M02.219 – Opens in a new window Postimmunization arthropathy, right shoulder – Postimmunization arthropathy, unspecified shoulder
M02.251 – M02.269 – Opens in a new window Postimmunization arthropathy, right hip – Postimmunization arthropathy, unspecified knee
M02.29 Postimmunization arthropathy, multiple sites
M02.311 – M02.319 – Opens in a new window Reiter’s disease, right shoulder – Reiter’s disease, unspecified shoulder
M02.351 – M02.369 – Opens in a new window Reiter’s disease, right hip – Reiter’s disease, unspecified knee
M02.811 – M02.819 – Opens in a new window Other reactive arthropathies, right shoulder – Other reactive arthropathies, unspecified shoulder
M02.851 – M02.869 – Opens in a new window Other reactive arthropathies, right hip – Other reactive arthropathies, unspecified knee
M02.9 Reactive arthropathy, unspecified
M05.011 – M05.019 – Opens in a new window Felty’s syndrome, right shoulder – Felty’s syndrome, unspecified shoulder
M05.051 – M05.069 – Opens in a new window Felty’s syndrome, right hip – Felty’s syndrome, unspecified knee
M05.09 Felty’s syndrome, multiple sites
M05.211 – M05.219 – Opens in a new window Rheumatoid vasculitis with rheumatoid arthritis of right shoulder – Rheumatoid vasculitis with rheumatoid arthritis of unspecified shoulder
M05.251 – M05.269 – Opens in a new window Rheumatoid vasculitis with rheumatoid arthritis of right hip – Rheumatoid vasculitis with rheumatoid arthritis of unspecified knee
M05.29 Rheumatoid vasculitis with rheumatoid arthritis of multiple sites
M05.311 – M05.319 – Opens in a new window Rheumatoid heart disease with rheumatoid arthritis of right shoulder – Rheumatoid heart disease with rheumatoid arthritis of unspecified shoulder
M05.351 – M05.369 – Opens in a new window Rheumatoid heart disease with rheumatoid arthritis of right hip – Rheumatoid heart disease with rheumatoid arthritis of unspecified knee
M05.39 Rheumatoid heart disease with rheumatoid arthritis of multiple sites
M05.411 – M05.419 – Opens in a new window Rheumatoid myopathy with rheumatoid arthritis of right shoulder – Rheumatoid myopathy with rheumatoid arthritis of unspecified shoulder
M05.451 – M05.469 – Opens in a new window Rheumatoid myopathy with rheumatoid arthritis of right hip – Rheumatoid myopathy with rheumatoid arthritis of unspecified knee
M05.49 Rheumatoid myopathy with rheumatoid arthritis of multiple sites
M05.511 – M05.519 – Opens in a new window Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder – Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified shoulder
M05.551 – M05.569 – Opens in a new window Rheumatoid polyneuropathy with rheumatoid arthritis of right hip – Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee
M05.59 Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites
M05.611 – M05.619 – Opens in a new window Rheumatoid arthritis of right shoulder with involvement of other organs and systems – Rheumatoid arthritis of unspecified shoulder with involvement of other organs and systems
M05.651 – M05.669 – Opens in a new window Rheumatoid arthritis of right hip with involvement of other organs and systems – Rheumatoid arthritis of unspecified knee with involvement of other organs and systems
M05.69 Rheumatoid arthritis of multiple sites with involvement of other organs and systems
M05.711 – M05.719 – Opens in a new window Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement – Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement
M05.751 – M05.769 – Opens in a new window Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement – Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement
M05.79 Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
M05.811 – M05.819 – Opens in a new window Other rheumatoid arthritis with rheumatoid factor of right shoulder – Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder
M05.851 – M05.869 – Opens in a new window Other rheumatoid arthritis with rheumatoid factor of right hip – Other rheumatoid arthritis with rheumatoid factor of unspecified knee
M05.89 Other rheumatoid arthritis with rheumatoid factor of multiple sites
M06.011 – M06.019 – Opens in a new window Rheumatoid arthritis without rheumatoid factor, right shoulder – Rheumatoid arthritis without rheumatoid factor, unspecified shoulder
M06.051 – M06.069 – Opens in a new window Rheumatoid arthritis without rheumatoid factor, right hip – Rheumatoid arthritis without rheumatoid factor, unspecified knee
M06.09 – M06.1 – Opens in a new window Rheumatoid arthritis without rheumatoid factor, multiple sites – Adult-onset Still’s disease
M06.211 – M06.219 – Opens in a new window Rheumatoid bursitis, right shoulder – Rheumatoid bursitis, unspecified shoulder
M06.251 – M06.269 – Opens in a new window Rheumatoid bursitis, right hip – Rheumatoid bursitis, unspecified knee
M06.29 Rheumatoid bursitis, multiple sites
M06.311 – M06.319 – Opens in a new window Rheumatoid nodule, right shoulder – Rheumatoid nodule, unspecified shoulder
M06.351 – M06.369 – Opens in a new window Rheumatoid nodule, right hip – Rheumatoid nodule, unspecified knee
M06.39 – M06.4 – Opens in a new window Rheumatoid nodule, multiple sites – Inflammatory polyarthropathy
M06.811 – M06.819 – Opens in a new window Other specified rheumatoid arthritis, right shoulder – Other specified rheumatoid arthritis, unspecified shoulder
M06.851 – M06.869 – Opens in a new window Other specified rheumatoid arthritis, right hip – Other specified rheumatoid arthritis, unspecified knee
M06.89 Other specified rheumatoid arthritis, multiple sites
M07.611 – M07.619 – Opens in a new window Enteropathic arthropathies, right shoulder – Enteropathic arthropathies, unspecified shoulder
M07.651 – M07.669 – Opens in a new window Enteropathic arthropathies, right hip – Enteropathic arthropathies, unspecified knee
M07.69 Enteropathic arthropathies, multiple sites
M08.011 – M08.019 – Opens in a new window Unspecified juvenile rheumatoid arthritis, right shoulder – Unspecified juvenile rheumatoid arthritis, unspecified shoulder
M08.051 – M08.069 – Opens in a new window Unspecified juvenile rheumatoid arthritis, right hip – Unspecified juvenile rheumatoid arthritis, unspecified knee
M08.09 Unspecified juvenile rheumatoid arthritis, multiple sites
M08.211 – M08.219 – Opens in a new window Juvenile rheumatoid arthritis with systemic onset, right shoulder – Juvenile rheumatoid arthritis with systemic onset, unspecified shoulder
M08.251 – M08.269 – Opens in a new window Juvenile rheumatoid arthritis with systemic onset, right hip – Juvenile rheumatoid arthritis with systemic onset, unspecified knee
M08.29 – M08.3 – Opens in a new window Juvenile rheumatoid arthritis with systemic onset, multiple sites – Juvenile rheumatoid polyarthritis (seronegative)
M08.411 – M08.419 – Opens in a new window Pauciarticular juvenile rheumatoid arthritis, right shoulder – Pauciarticular juvenile rheumatoid arthritis, unspecified shoulder
M08.451 – M08.469 – Opens in a new window Pauciarticular juvenile rheumatoid arthritis, right hip – Pauciarticular juvenile rheumatoid arthritis, unspecified knee
M08.811 – M08.819 – Opens in a new window Other juvenile arthritis, right shoulder – Other juvenile arthritis, unspecified shoulder
M08.851 – M08.869 – Opens in a new window Other juvenile arthritis, right hip – Other juvenile arthritis, unspecified knee
M08.89 Other juvenile arthritis, multiple sites
M08.911 – M08.919 – Opens in a new window Juvenile arthritis, unspecified, right shoulder – Juvenile arthritis, unspecified, unspecified shoulder
M08.951 – M08.969 – Opens in a new window Juvenile arthritis, unspecified, right hip – Juvenile arthritis, unspecified, unspecified knee
M08.99 Juvenile arthritis, unspecified, multiple sites
M1A.0110 – M1A.0191 – Opens in a new window Idiopathic chronic gout, right shoulder, without tophus (tophi) – Idiopathic chronic gout, unspecified shoulder, with tophus (tophi)
M1A.0510 – M1A.0691 – Opens in a new window Idiopathic chronic gout, right hip, without tophus (tophi) – Idiopathic chronic gout, unspecified knee, with tophus (tophi)
M1A.09X0 – M1A.09X1 – Opens in a new window Idiopathic chronic gout, multiple sites, without tophus (tophi) – Idiopathic chronic gout, multiple sites, with tophus (tophi)
M1A.2110 – M1A.2191 – Opens in a new window Drug-induced chronic gout, right shoulder, without tophus (tophi) – Drug-induced chronic gout, unspecified shoulder, with tophus (tophi)
M1A.2510 – M1A.2691 – Opens in a new window Drug-induced chronic gout, right hip, without tophus (tophi) – Drug-induced chronic gout, unspecified knee, with tophus (tophi)
M1A.29X0 – M1A.29X1 – Opens in a new window Drug-induced chronic gout, multiple sites, without tophus (tophi) – Drug-induced chronic gout, multiple sites, with tophus (tophi)
M1A.3110 – M1A.3191 – Opens in a new window Chronic gout due to renal impairment, right shoulder, without tophus (tophi) – Chronic gout due to renal impairment, unspecified shoulder, with tophus (tophi)
M1A.3510 – M1A.3691 – Opens in a new window Chronic gout due to renal impairment, right hip, without tophus (tophi) – Chronic gout due to renal impairment, unspecified knee, with tophus (tophi)
M1A.39X0 – M1A.39X1 – Opens in a new window Chronic gout due to renal impairment, multiple sites, without tophus (tophi) – Chronic gout due to renal impairment, multiple sites, with tophus (tophi)
M1A.4110 – M1A.4191 – Opens in a new window Other secondary chronic gout, right shoulder, without tophus (tophi) – Other secondary chronic gout, unspecified shoulder, with tophus (tophi)
M1A.4510 – M1A.4691 – Opens in a new window Other secondary chronic gout, right hip, without tophus (tophi) – Other secondary chronic gout, unspecified knee, with tophus (tophi)
M1A.49X0 – M1A.49X1 – Opens in a new window Other secondary chronic gout, multiple sites, without tophus (tophi) – Other secondary chronic gout, multiple sites, with tophus (tophi)
M10.011 – M10.019 – Opens in a new window Idiopathic gout, right shoulder – Idiopathic gout, unspecified shoulder
M10.051 – M10.069 – Opens in a new window Idiopathic gout, right hip – Idiopathic gout, unspecified knee

FAQs

Can 20610 and 20605 be billed together? ›

When we code bilateral joint aspiration on both sides, we can use the 50 along with procedure cpt code 20600, 20604, 20605, 20606, 20610 and 20611. But, when the joint aspiration is done on two different small joint or major joints, we have to use 59 modifier with any of the cpt.

Can CPT code 20610 and 20611 be billed for injection contrast? ›

The procedure code (CPT code) 20610 or 20611 (with ultrasound guidance) may be billed for the intra-articular injection in addition to the drug. If an aspiration and an injection procedure are performed at the same session, bill only one unit for CPT code 20610 or 20611 (if applicable).

What is the difference between CPT 20610 and 20611? ›

Use 20610 for a major joint or bursa, such as the shoulder, knee, or hip joint, or the subacromial bursa when no ultrasound guidance is used for needle placement. Report 20611 when ultrasonic guidance is used and a permanent recording is made with a report of the procedure.

How do I bill a CPT code 20610? ›

Billing the injection procedure

The procedure code (CPT code) 20610 or 20611 may be billed for the intraarticular injection. The charge, if any, for the drug or biological must be included in the physician's bill and the cost of the drug or biological must represent an expense to the physician.

Does CPT code 20605 need a modifier? ›

The biller billed the CPT code 20605 (Arthrocentesis, aspiration and/or injection; intermediate joint, bursa or ganglion cyst ) without the modifier-50.

How many times can 20610 be billed? ›

The MUI indicator for CPT 20610 is 2. This means that no more than 2 units per DOS can be billed. Any service performed and billed more than allowed units will be denied.

Does CPT code 20600 need a modifier? ›

Bill two line items with CPT code 20600 (arthrocentesis, aspiration and/or injection; small joint or bursa) Append modifier -LT as the primary modifier on one line, and -RT to the other to indicate a bilateral service.

Can you bill an office visit with 20610? ›

Because the E/M is significant and determines the need for the aspiration, you may report both 20610 and the documented E/M service with modifier 25 appended (e.g., 99213-25 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: ...

Can you bill an office visit with a joint injection? ›

Answer: Unfortunately, no. It is true that an evaluation and management code, an E/M or office visit, can be reported with a minor procedure such as an injection, but only if the E/M is significant and separate and exceeds the “pre-service evaluation” that is inherent to the injection.

Can CPT code 20610 be billed with 99213? ›

Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.

What revenue code should be billed with 20610? ›

Joint Aspiration/Injection Coding – Important Billing Points

According to Centers for Medicare & Medicaid (CMS) guidelines, one unit of 20610 should be reported with modifier 50 Bilateral procedure appended if aspirations and/or injections occur on opposite, paired joints (e.g., both knees).

What does CPT code 20610 mean? ›

Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance.

Can you Bill 20611 twice? ›

Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. You may report multiple units of a single code for aspiration/injection of multiple joints of same size (e.g., two large joints, left knee and left shoulder).

CAN J3301 and 20610 be billed together? ›

yes you can bill 20610 with J3301.

Are knee injections covered by Medicare? ›

Yes, Medicare will cover knee injections that approved by the FDA. This includes hyaluronan injections. Medicare does require that the doctor took x-rays to show osteoarthritis in the knee. The coverage is good for one injection every 6 months.

Is 20610 a bilateral code? ›

20610 has a bilateral payment indicator of "1". 20610 is eligible for modifier 50.

Can 20610 and 23700 be billed together? ›

* Shoulder Joint Manipulation code is 23700. This procedure may be performed in the same case with a Joint Injection (code 20610) on the same joint. This procedure is usually performed for Adhesive Capsulitis, for post-shoulder replacement stiffness and for “frozen shoulder” conditions.

Can 20550 and 20610 be billed together? ›

For 20550/20551 being billed with 20610 the modifier you use will depend on the insurance. If the patient has any type of Medicare plan then use -XS. If not, -59. These modifiers communicate to insurance that the injections were performed for separate and unrelated medical conditions.

Can CPT code 20610 be billed with 99214? ›

yes 25 would be with 99214 and you will add RT with 20610. Your claim would be paid.

How do you code joint injections? ›

If the provider performs joint aspiration/injection with US guidance, select 20604, 20606, or 20611 (depending on the joint targeted). If the provider aspirates/injects the joint/bursa without guidance of any kind, select from among 20600, 20605, and 20610.

How do you code bilateral knee injections? ›

Coding Rationale

The CPT code 20611 is for an arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee or subacromial bursa with ultrasound guidance, with permanent recording and reporting). The code is billed twice because this was a bilateral procedure.

Can CPT 20610 and 96372 be billed together? ›

They are not used together for the same injection. The 20610 or 20605 are the admin codes for the joint injection the J code is the drug/substance injected. The 96372 is not coded for a joint injection.

Can 20610 and 76942 be billed together? ›

One CMD suggests that the payment for CPT code 76942 and CPT code 20610 should be combined to reduce the incentive for providers to always provide and bill separately for ultrasound guidance.

How do you bill a ketorolac injection? ›

J1885 is a valid 2022 HCPCS code for Injection, ketorolac tromethamine, per 15 mg or just “Ketorolac tromethamine inj” for short, used in Medical care.

Can you bill an office visit and a procedure on the same day? ›

Can you bill an E/M service on the same day as a minor procedure? Sometimes yes, sometimes no. The decision to perform a minor procedure is included in the payment for the procedure, unless a significant and separate E/M is needed, performed and documented.

Can you bill a nurse visit with an injection? ›

One word of caution about 99211: You can't bill for the administration of an injectable medication (90782) or for the administration of an immunization (90471, 90472) and a nursing visit at the same time. You can either bill for the 99211 plus the medications or bill for the injection plus the medications.

What is the CPT code for knee injection? ›

20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa) with ultrasound guidance, with permanent recording and reporting. If no guidance was used for the injection, then CPT codes 20600-20610 will be billed based on the anatomical site.

How do you only inject a bill? ›

If you administer an injection in your office, e.g., naltrexone extended-release (Vivitrol®) or depot antipsychotics, you can bill for the administration of the injection separately from the billing for the visit itself. The CPT code 96372 should be used–Therapeutic, prophylactic, or diagnostic injection.

When do you use modifier 25? ›

Modifier 25 – this Modifier is used to report an Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified health care professional.

What is a 50 modifier? ›

Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).

How many times should code 20550 be reported when multiple injections are administered to the same tendon? ›

You should report 20552 and 20553 only once per session, regardless of the number of injections or muscles involved. You should also report 20550 and 20551 only once per tendon sheath, ligament, or tendon origin/insertion, regardless of the number of injections involved.

What is the CPT code for steroid injection? ›

A transforaminal epidural steroid injection (TFESI) performed at the T12-L1 level should be reported with CPT code 64479. When reporting CPT codes 64479 through 64484 for a unilateral procedure, use one line with one unit of service.

Under what circumstances would modifier 59 not be appropriate? ›

Modifier 59 should not be used on Evaluation and Management Codes, and should only be used when no other modifier is accurate. Although it does not require a different diagnosis for each coded procedure, a different diagnosis also does not necessarily justify the use of the modifier.

Does Medicare cover Hymovis injections? ›

Medicare reimburses HYMOVIS at ASP+6% Check the CMS web site for current Medicare reimbursement amounts for HYMOVIS at: www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/index.html Contact private payers or consult contracts for their reimbursement amounts.

Does CPT code 20610 include fluoroscopy? ›

If you are injecting a steroid or anesthetic agent into the hip joint under fluoroscopic guidance, you would report 20610 for the major joint injection and 77002 for the use of the fluoroscope for needle guidance, according to the June 2012 CPT Assistant.

What is the CPT code for knee pain? ›

M25. 569 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM M25.

Is hip injection CPT code? ›

CPT code 20610 (major joint injection) is included in this list.

How do you bill bilateral knee injections? ›

Coding Rationale

The CPT code 20611 is for an arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee or subacromial bursa with ultrasound guidance, with permanent recording and reporting). The code is billed twice because this was a bilateral procedure.

How do I bill multiple 20610? ›

If the provider performs injections on separate, non-symmetrical joints (e.g., left shoulder and right knee), you may report two units of 20610 and append modifier 59 Distinct procedural service to the second unit (e.g., 20610, 20610-59) to indicate the second procedure occurred at a different joint.

Do you need a modifier for 20600? ›

Bill two line items with CPT code 20600 (arthrocentesis, aspiration and/or injection; small joint or bursa) Append modifier -LT as the primary modifier on one line, and -RT to the other to indicate a bilateral service.

Can I bill an office visit with a joint injection? ›

Answer: Unfortunately, no. It is true that an evaluation and management code, an E/M or office visit, can be reported with a minor procedure such as an injection, but only if the E/M is significant and separate and exceeds the “pre-service evaluation” that is inherent to the injection.

What revenue code should be billed with 20610? ›

Joint Aspiration/Injection Coding – Important Billing Points

According to Centers for Medicare & Medicaid (CMS) guidelines, one unit of 20610 should be reported with modifier 50 Bilateral procedure appended if aspirations and/or injections occur on opposite, paired joints (e.g., both knees).

Can CPT code 20610 be billed with 99213? ›

Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.

Is CPT code 20610 considered surgery? ›

The Division finds that reimbursement is not due based upon the following: • Code 20610 is classified as a minor surgery because it has a 0 day postoperative period.

Can you Bill 20611 twice? ›

Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. You may report multiple units of a single code for aspiration/injection of multiple joints of same size (e.g., two large joints, left knee and left shoulder).

Is CPT 20610 an add on code? ›

If fluoroscopic guidance is performed for needle placement, the add-on CPT code 77002 would be listed separately in addition to the intra-articular injection procedure CPT code 20610.

Can you Bill 20600 twice? ›

Reporting Multiple Units. Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. You may report multiple units of a single code for aspiration/injection of multiple joints of same size.

Can you bill modifier 50 and 59 together? ›

As long as the coding submitted supports separate payment, there should be no issues. If only one procedure was performed bilaterally, modifier -59 should not be used on the charge with modifier -50.

Can CPT 20610 and 96372 be billed together? ›

They are not used together for the same injection. The 20610 or 20605 are the admin codes for the joint injection the J code is the drug/substance injected. The 96372 is not coded for a joint injection.

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