Can you bill multiple units of 20550?
Asked by: Christiana Homenick | Last update: August 31, 2025Score: 4.7/5 (55 votes)
Can 20550 be billed with 2 units?
The 50 modifier identifies a BILATERAL PROCEDURE. In this instance CPT code 20550 would be billed at 1 unit since the 50 modifier automatically implies 2 units and the fee for performing the procedure one time would be doubled.
What is CPT code 20550 billing guidelines?
CPT code 20550 is used for an injection into a tendon sheath or ligament. This procedure typically involves administering medication directly into the sheath surrounding a tendon or into a ligament to reduce inflammation and pain.
Can you bill 2 units 20610?
For example, if the provider performs an aspiration and injection on the left knee and a separate aspiration and injection on the right knee, two units of the 20610 code can be reported, each with the designated modifiers for bilateral procedures.
Can you bill multiple units of 97530?
Briefly, the eight-minute rule states that you must perform the activity for a minimum of eight, and a maximum of 22 minutes in order to bill for one unit of that code. If the treatment extends beyond 22 minutes, the therapist may bill for multiple units.
Medical Billing & Coding Pro Tip 3: Don't Be Afraid to Bill 992x5 if Indicated!
Do you bill 2 units with a 50 modifier?
If a procedure is authorized for the 150 percent payment adjustment for bilateral procedures (payment policy indicator 1), the procedure shall be reported on a single line item with the 50 modifier and one service unit. Whenever the 50 modifier is appended, the appropriate number of service units is one.
What is the rule of 8 billing for Medicare?
When Medicare reviews your claim, they will divide the total minutes for all timed services by 15. If the result of the equation leaves at least 8 minutes remaining before hitting another 15-minute increment, you can bill an extra unit. If there are less than 8 minutes, you cannot bill an extra unit.
How to bill 99213 and 20610 together?
Use the E/M code with a modifier (for example, 99213-25), as well as the knee joint aspiration procedure code 20610. Thus, when a new problem requires more than a cursory review, the visit generally qualifies for an E/M with modifier -25.
What is the maximum number of units of 20610 you may report per session per joint treated?
Billing the injection procedure
If an aspiration and an injection procedure are performed at the same session, bill only 1 unit for CPT code 20610 or 20611. When additional substances are concomitantly administered (e.g. cortisone, anesthetics) with viscosupplementation, only one injection service is allowed per knee.
Can you bill 2 units of 96127?
CMS does not limit the number of times CPT code 96127 may be billed per year. There is an MUE limit of 3 units per date of service. Although major insurances typically follow MUE guidelines, they may impose their own limits on the number of times per year that 96127 may be billed.
Does CPT 20550 need a modifier?
Does CPT 20550 Need a Modifier? - Use this modifier if the injection is performed on both sides of the body during the same session. - Apply this modifier when multiple procedures, other than E/M services, are performed by the same provider during the same session.
Is 20550 a trigger point injection?
Answer: CPT code 20550 defines an injection to a single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”). CPT code 20551 defines an injection to single tendon at the origin/insertion site. Trigger finger injections are most commonly given to the flexor tendon, supporting CPT code 20550.
What is 20550 UHC policy?
UnitedHealthcare Community Plan reimburses for injections into the tendon/tendon sheath, or ligament (CPT codes 20550, 20551) ganglion cyst (CPT code 20612), and carpal tunnel or tarsal tunnel (CPT code 20526) when one of the diagnosis codes are listed on a claim denoting a problem with one of these regions.
Can you bill 20552 twice?
Only one code from 20552 or 20553 should be reported on any particular day, no matter how many sites or regions are injected. When a given site is injected, it will be considered one injection service, regardless of the number of injections administered.
What is procedure code 20550?
The Current Procedural Terminology (CPT®) code 20550 as maintained by American Medical Association, is a medical procedural code under the range - General Introduction or Removal Procedures on the Musculoskeletal System.
How do I bill for 2 injections?
If a provider wishes to report multiple injections (intramuscular or subcutaneous) of the same therapeutic medication, he or she may choose to report code 96372 (therapeutic, prophylactic, or diagnostic injection [specify substance or drug]). The number of administrations would be reported as the units of service.
How many units can I bill 20550?
20550 cannot be billed with units greater than 1.
How to bill multiple units of 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.
What is the bilateral procedure rule?
CMS defines a bilateral service as one in which the same procedure is performed on both sides of the body during the same operative session or on the same day.
When to use 59 or 51 modifier?
Modifier -51 would be attached because the biopsy is the lesser-valued procedure done at the same session, and modifier -59 would be attached to indicate that the biopsy, which is normally bundled with excision of the same lesion, was done on a separate lesion from the one that was excised.
What is the modifier 25 rule?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
Can 20610 and 20552 be billed together?
Reader Question: 20552 Might Be Bundled Into 20610
Pay attention: If the injections are administered in different anatomic locations, you can report both codes. However, because code 20552 is a Column 2 code for 20610, append a modifier to 20552 to differentiate the services and override the CCI bundle.
What is the golden rule in medical billing?
The golden rule of healthcare billing and coding departments is, “Do not code it or bill for it if it's not documented in the medical record.” Providers use clinical documentation to justify reimbursements to payers when a conflict with a claim arises.
What is the 2 2 2 rule in Medicare?
Introduced in the Fiscal Year 2014 Inpatient Prospective Payment System (IPPS) Final Rule, the two-midnight rule specifies that Medicare will pay for inpatient hospital admissions when a physician reasonably expects the patient's care to require a stay that crosses two midnights, and the medical record supports this ...