What is cpt code 20610?
Asked by: Chance Rogahn V | Last update: November 14, 2025Score: 4.7/5 (17 votes)
What is CPT code 20610 billing guidelines?
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.
Is 20610 considered surgery?
The 20610 CPT code is used in medical procedures involving arthrocentesis, aspiration, and/or injection of major joints or bursae. This code is primarily utilized to remove fluid from joints for diagnostic analysis or to administer medication for pain relief and inflammation reduction.
What is the CPT code for kenalog injection?
The CPT code for a Kenalog injection is J3301 when using a 10 mg dose of triamcinolone acetonide. Kenalog is a brand name for triamcinolone acetonide, and J3301 applies to this injectable corticosteroid in 10 mg doses.
What is CPT code 20610 for SI joint injection?
CPT® 20610 describes aspiration (removal of fluid) from, or injection into, a major joint (defined as a shoulder, hip, knee, or subacromial bursa), or both aspiration and injection of the same joint. The procedure may be performed for diagnostic analysis and/or to relieve pain and swelling in the joint.
CPT 20610 Documentation Requirements
What are the symptoms of sacroiliac joint dysfunction?
Too much movement (hypermobility or instability): The pain is typically felt in the lower back and/or hip and may radiate into the groin area. Too little movement (hypomobility or fixation): The pain is typically felt on one side of the lower back or buttocks and can radiate down the leg.
What is the right CPT for sacroiliac joint injection?
Injections of the nerves innervating the sacroiliac joint should be reported with CPT 64451. CPT 64451 includes imaging guidance. Imaging codes should not be reported with CPT 64451. Critical Access Hospitals (TOB 85X) should report sacroiliac joint injection with CPT 27096 and a sacral nerve block with CPT 64451.
Will Medicare pay for a Kenalog injection?
this drug is slightly more popular than comparable drugs. It is available in brand and generic forms. It is not covered by most Medicare and insurance plans, but manufacturer and pharmacy coupons can help offset the cost. Compare corticosteroids.
What is the CPT code for joint injection?
Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. CPT® allows you to separately report fluoroscopic, CT, or MRI guidance for needle placement during joint/bursa aspiration/injection, when performed.
What is a kenalog injection used for?
Each injection contains triamcinolone acetonide 40 mg/ml as the active ingredient. Triamcinolone acetonide belongs to a group of medicine called corticosteroids (steroids). Kenalog IA/IM Injection is for the treatment of joint pain, swelling and stiffness in inflammatory disorders such as rheumatoid arthritis.
Does Medicare pay for 20610?
Medicare does reimburse for CPT code 20610, which pertains to the drainage or injection of a joint or bursa without the use of ultrasound guidance. The reimbursement amount can vary based on several factors, including geographic location and the specific Medicare Administrative Contractor (MAC) overseeing the claim.
How much does arthrocentesis cost?
Across all facilties, the average cash price for Joint arthrocentesis is $521. However, the price you pay varies significantly based on your location and any insurance coverage.
Can you bill 99213 and 20610 together?
Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.
Are hyaluronic acid injections covered by insurance?
Most insurance plans cover hyaluronic acid injections for symptomatic knee osteoarthritis not responding to other treatments. They often require that patients first try other treatments like physical therapy. Some insurance plans may only cover certain brands of shots.
Does 20610 include lidocaine?
20610 is the admin code. Drug can be billed separately as long as its not the local anesthesia, lidocaine for example .
How much do knee gel injections cost?
Knee Gel Injection Cost without Insurance
Depending on your location and options, the out of pocket costs for knee gel injections can range from around $1,000 to $2,500 for a series.
What diagnosis is covered by CPT code 20610?
Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance.
How often will Medicare pay for cortisone knee injections?
Medicare will cover knee injections once every six months if they are medically necessary. The injections are covered under Medicare Part B and subject to the annual Part B deductible. X-rays are required prior to Medicare approval.
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.
How much does a kenalog 10 injection cost?
Kenalog-10 (triamcinolone) is a member of the glucocorticoids drug class and is commonly used for Alopecia, Bursitis, Dermatological Disorders, and others. The cost for Kenalog-10 (10 mg/mL) injectable suspension is around $22 for a supply of 5 milliliters, depending on the pharmacy you visit.
What are the 6 things Medicare doesn't cover?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
Is dupixent covered by Medicare?
Medicare Advantage and Part D plans may cover Dupixent for people who have moderate to severe disease. Other options besides Medicare may make Dupixent more affordable, such as Dupixent SingleCare coupons, a manufacturer copay card, and a patient assistance program.
How much does a sacroiliac joint injection cost?
How much does a sacroiliac joint injection cost? The cost of a sacroiliac joint injection is $900 to $1200. It's usually covered by health insurance.
What is the CPT code for two joint injections?
If aspirations and/or injections occur on opposite, paired joints (e.g., both knees), report one unit of 20610 with modifier 50 Bilateral procedure appended, per Centers for Medicare and Medicaid (CMS) instruction.
Is the SI joint a major joint?
The SI joints are the major connection joints between the upper and lower body. They have a minor rocking motion, and if they are injured or deteriorated they can be a significant source of pain. The pain is caused by damage or injury to this joint that is located between the sacrum and the hip.