What is the maximum number of units of 20610 you may report per session per joint treated?
Asked by: Prof. Jakob Bergstrom | Last update: November 3, 2025Score: 4.8/5 (41 votes)
How many units of 20610 can be billed?
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.
How do I bill multiple 20610?
Multiple Units and Bilateral Procedures for 20610 CPT Code
If the procedure is performed in more than one major joint, each joint can be reported with a separate unit of the 20610 code.
Are the maximum number of units of service a provider can report under most circumstances?
An MUE for a HCPCS/CPT code is the maximum number of units of service under most circumstances able to be reported by the same provider for the same beneficiary on the same date of service.
Can you bill 20610 with 50 modifiers?
The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or CPT code 20611 to indicate if the service was performed unilaterally and modifier (-50) must be appended to indicate if the service was performed bilaterally.
CPT 20610 Billing Scenarios
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 modifier 52 rule?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
What is the maximum units of service?
An MUE is the maximum units of service (UOS) reported for a HCPCS/CPT code on the vast majority of appropriately reported claims by the same provider/supplier for the same beneficiary on the same date of service. Not all HCPCS/CPT codes have an MUE.
What indicates the maximum number of units of service allowed on the same date of service?
An MUE for a HCPCS/CPT code is the maximum number of units of service (UOS) reportable under most circumstances by the same provider/supplier for the same beneficiary on the same date of service. The ideal MUE value for a HCPCS/CPT code is one that allows the vast majority of appropriately coded claims to pass the MUE.
Which of the following is the maximum number of diagnoses that can be reported on the CMS 1500 claim form before an additional claim is required?
MULTIPLE PAGE CLAIMS
If more than 12 diagnoses are required to report the line services, the claim must be split and the services related to the additional diagnoses must be billed as a separate claim.
Can you bill multiple units of 20550?
The description for CPT 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]) means that if your physician injects a single tendon sheath multiple times, you should report 20550 once. But if he injects two tendon sheaths, you should assign 20550 twice, says Kent J.
Can you bill 20610 and 77002 together?
Answer: Yes, you can report fluoroscopic guidance with CPT code 20610. In the ASC make sure you report 77002-26.
What is CPT code 20610 for large joint injection?
In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a drug into the joint for therapeutic purpose. He performs this procedure without using ultrasound guidance.
How do you bill multiple 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 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.
Can you bill 2 units of 97012?
The time devoted to patient education related to the use of home traction should be billed under 97012. Only 1 unit of CPT code 97012 is generally covered per date of service.
What is the maximum units for 95165?
When billing code 95165, providers should report the number of units representing the number of 1 cc doses being prepared. A maximum of 10 doses per vial is allowed for Medicare billing, even if more than ten preparations are obtained from the vial.
Can CPT II codes be billed alone?
Report the appropriate CPT II code for the LDL-C result value. CPT Category II codes can be reported alone on a claim with $0.00 value (or $0.01 value if your system requires it in order for the codes to populate on a claim).
What is the separate procedure rule?
6. CPT “Separate procedure” definition: The narrative for many HCPCS/CPT codes includes a parenthetical statement that the procedure represents a "separate procedure". The inclusion of this statement indicates that the procedure can be performed separately but should not be reported when a related service is performed.
What does the number of days or units of service exceed our acceptable maximum mean?
This remark code represents “the number of days or units of service exceeds our acceptable maximum” and may mean your claim has fallen afoul of the MUEs. You can also use MUEs to assist you with appeals. Sometimes a submitted CPT® code may get denied with an indicator that it cannot be billed more than once in a day.
What are units of service?
Units of Service - the number of units of the items or services delivered. (One claim may have multiple units of service for an item or service.)
Does Medica follow Medicare guidelines?
The Medica Prime Solution® product is governed primarily by Centers for Medicare and Medicaid Services (CMS) rules and regulations.
What is the modifier 51 rule?
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to: Different procedures performed at the same session. A single procedure performed multiple times at different sites.
What are modifier rules?
Modifier Basics
A modifier is a word, phrase, or clause that modifies—that is, gives information about—another word in the same sentence. For example, in the following sentence, the word "burger" is modified by the word "vegetarian": Example: I'm going to the Saturn Café for a vegetarian burger.
What is the difference between 54 and 55 modifier?
The use of modifier 54 indicates the surgeon has transferred postoperative care (partial or total) to another provider, and the surgical code with modifier 55 appended will be billed by the receiving provider to whom the postoperative care was transferred.