20610 cpt code reimbursement. Dec 1, 2018 · The procedure code (CPT code) 20610 or 20611 may be billed for the intraarticular injection. I looked up the CCI Oct 27, 2016 · The example large joints listed for code 20610 include: shoulder, hip, knee, subacromial bursa. , left shoulder and right knee), report two units of the aspiration/injection code and append modifier 59 Distinct procedural service to the second unit (e. Example 1: The procedure was 20610. com May 30, 2025 · Learn when and how to use CPT code 20610 for joint aspiration or injection without ultrasound. If no permanent images are saved, the coder must assign the arthrocentesis code designates without ultrasound guidance (20600, 20605, or 20610). Billing and Coding Guidelines For viscosupplementation injections, the primary CPT codes are 20610 and 20611. Jul 8, 2010 · My doc is doing Bilateral injections on knee w/bilateral injection of Depomedrol 80 mg. Nov 14, 2023 · CPT (Current Procedural Terminology) codes are used in the United States to report medical procedures and services. The correct We can use the 50 along with procedure CPT codes 20600, 20604, 20605, 20606, 20610, and 20611 to code bilateral joint aspiration on both sides. That’s why with ZILRETTA® (triamcinolone acetonide extended-release injectable suspension), we’re providing the simplicity of a medical benefit product with broad coverage and a permanent, product-specific J-code. , CPT® 20610) may be appropriate to indicate which knee was injected. As with all ultrasound codes, the CPT code descriptor requires permanent recording of the ultrasound image to report any “with ultrasound guidance” codes. CPT® RVU calculator provides a quick analysis of the work relative value units associated with a certain volume of CPT or HCPCS codes. What is CPT Code 20610 CPT code 20610 is used for a procedure where a healthcare provider drains fluid from or injects medication into a joint or bursa without using ultrasound guidance. 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. It is important to note that this code cannot be used in conjunction with codes that indicate the use of ultrasound guidance during the procedure. I billed a 20610 RT and J3301 x 4 with dx M70. 61. , M05. Understanding Basics of Orthopedic Injection Coding Accurate billing for orthopedic injections is essential for ensuring proper compensation for your services. The following codes should be Q: My coders tell me that billing anesthetic drugs with injection procedures is unbundling and are reversing charges on outpatient clinic encounters. May 30, 2025 · Learn when and how to use CPT code 20610 for joint aspiration or injection without ultrasound. For example, a patient presents to the office for an injection of 40 mg of triamcinolone to the right hip for trochanteric bursitis of the right hip. Coverage depends on the specific insurance provider, and documentation must clearly justify the medical necessity for the procedure. If the drug was administered bilaterally, a -50 modifier should be used with May 30, 2017 · If the provider performs injections on separate, non-symmetrical joints (e. Dec 21, 2024 · For instance, if Triamcinolone Acetonide is injected into a joint, CPT code 20610 (arthrocentesis, aspiration and/or injection, major joint or bursa) would be used for the procedure itself, in addition to J3301 for the medication. For example, the CPT code 20610 (injection, major joint or bursa) or 20550 (injection, tendon sheath, ligament, trigger points or ganglion cyst) is reported along with the HCPCS J code to Upon request, we will provide an explanation of how EmblemHealth handles specific coding issues. UnitedHealthcare reimbursement policies may use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. In simple terms, it refers to a medical procedure in which a healthcare provider treats joint pain by inserting a needle into a major joint or bursa (a fluid-filled sac cushioning spaces between bones, muscles, and other tissues). CPT 20610: This code is used for a standard intra-articular injection without any imaging guidance. Includes documentation tips, modifiers, related codes, and billing guidelines. This procedure is essential for diagnosing and treating joint-related conditions such as arthritis, synovitis, and bursitis. Apr 29, 2019 · Is anyone getting denials on 20610? (This was to Aetna/Coventry Medicare). 20610-20611 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, 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 Jan 13, 2025 · CPT code 20610 is commonly used for diagnoses such as osteoarthritis, rheumatoid arthritis, bursitis, synovitis, and joint effusion. Mar 17, 2020 · For 20550/20551 being billed with 20610 the modifier you use will depend on the insurance. The reimbursement amount can vary based on geographic location and other factors, but as of the latest data, the national average reimbursement rate for this procedure is approximately $150. Refer to the Medical Benefit Drug Policy titled Medical Benefit Therapeutic Equivalent Medications We can use the 50 along with procedure CPT codes 20600, 20604, 20605, 20606, 20610, and 20611 to code bilateral joint aspiration on both sides. 60. COMMON ICD-10 CODES IN RHEUMATOLOGY Proper diagnostic coding ensures that claims pass payor edits and comply with medical necessity. Jun 11, 2025 · Learn how to bill lidocaine injections accurately, including CPT codes, administration routes, and compliance tips to ensure proper reimbursement and avoid denials. Indicate which knee was injected by using the RT (right) or LT (left) modifier (FAO-10 electronically) on the injection procedure (CPT 20610). Humana`s guidelines for the claim coding and claim payment inquiry process with links to facilitate documentation and coding diagnoses and services. Arthrocentesis CPT Codes are 20600, 20610, and 20605 and procedure Arthrocentesis involves fluid aspiration (withdrawal) from a joint space using a needle. Jul 31, 2025 · What are the billing guidelines for 20610? The procedure code (CPT code) 20610 or 20611 may be billed for the intraarticular injection. g. Jun 18, 2018 · How do you code procedures 20610 and 20552 together with the appropriate modifier to prevent bundling? CPT code 20610 is used for a procedure where a healthcare provider drains fluid from or injects medication into a joint or bursa without using ultrasound guidance. For example, if arthrocentesis is performed on the shoulder and hip joint, the 20610 and 20610-59 modifiers can be coded Aug 21, 2022 · Billing the injection procedure: The CPT® code (procedure code) 20610 or 20611 (with ultrasound guidance) may be billed for the intra-articular injection in addition to the drug. Below is a list of potential modifiers that could be used with CPT code 20605, along with the reasons for their use: 1. And don’t forget to bill the HCPCS II code for the medication itself. Place the CPT code 20610 in item 24D. This code typically applies to treatments for conditions like arthritis or bursitis to relieve pain and inflammation. Learn about this aspiration and/or or injection of fluid from major joints today. Mar 19, 2023 · Use this page to view details for the Local Coverage Article for Billing and Coding: Sacroiliac Joint Injections and Procedures. Jun 24, 2025 · What are the billing guidelines for 20610? The procedure code (CPT code) 20610 or 20611 may be billed for the intraarticular injection. We also offer you expertise and support services to help your practice CPT code 20610 is used for a procedure where a healthcare provider drains fluid from or injects medication into a joint or bursa without using ultrasound guidance. Mar 7, 2025 · CPT Code 20610 – Description So, what exactly does this code cover? CPT code 20610 is widely used in rheumatology and orthopedics billing. Wabash Ave. Can you bill multiple units of 20550? The description for CPT 20550 (Injection (s Jul 2, 2025 · Learn CPT® 20610 for joint injections or aspirations, with guidance on coding, documentation, and tools to streamline in-office procedures. Modifier 50 - Bilateral What is CPT Code 20610 CPT code 20610 is used for a procedure where a healthcare provider drains fluid from or injects medication into a joint or bursa without using ultrasound guidance. BILLING CODING KNEE INJECTION HYALGAN, SUPARTZ, VISCO, GENVISC, SYNVISC - J7325, J7321, J7328 20610 and more J-codes! Please review the licensing information below and indicate your agreement and acceptance. See full list on aapc. If appropriate coding/billing guidelines or current reimbursement policies are not followed, EmblemHealth may deny the claim and/or recoup claim payment. This should be reflected in the diagnosis codes that they are pointed to as well. These modifiers communicate to insurance that the injections were performed for separate and unrelated medical conditions. Coverage reviews may be in place if required by law or the benefit plan. If an aspiration and an injection procedure are performed at the same session, bill only 1 unit for CPT® code 20610 or 20611. CODING INFORMATION At Pacira, we understand that coding and billing can be confusing and time-consuming. If the procedure is performed on multiple joints, separate codes should be reported for each joint. Coverage Rationale Gel-One, GenVisc 850, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz, Synojoynt, Synvisc or Synvisc-One, Triluron, TriVisc, and Visco-3 are typically excluded from coverage. Do you need modifier 25 with 96372? required for the Injection service, Modifier 25 may The Current Procedural Terminology (CPT ®) code 20610 as maintained by American Medical Association, is a medical procedural code under the range - General Introduction or Removal Procedures on the Musculoskeletal System. Jun 18, 2018 · How do you code procedures 20610 and 20552 together with the appropriate modifier to prevent bundling? CODING INFORMATION At Pacira, we understand that coding and billing can be confusing and time-consuming. Here are the CPT codes associated with arthrocentesis procedures: 3. , 20610, 20610-59). Jan 20, 2024 · The American Medical Association maintains CPT code 20610 to cover the professional service of performing specific procedures for billing purposes. However, when performing joint aspiration on two different small or major joints, we must use a 59 modifier with any of the CPT. If the physician performs the AC injection utilizing ultrasound guidance with permanent recording and reporting, then you should report code 20606 instead of 20605. 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. Coding is straightforward. Jul 25, 2018 · Joint Aspiration/Injection Coding – Important Billing Points CPT recommends reporting a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. CPT 20610 can be reported for a major joint or bursa injection or aspiration without ultrasound guidance. The service or procedure the patient requires is identified by a CPT code. May 28, 2025 · What is CPT code 20610 billing guidelines? The procedure code (CPT code) 20610 or 20611 may be billed for the intraarticular injection. Here are the ICD-10 codes rheumatology practices frequently use: CPT 20610 - Arthrocentesis, aspiration and/or injection into, a major joint or bursa (eg, shoulder, hip, knee, or subacromial bursa); without ultrasound guidance Tip: Always link a medically necessary ICD-10 code to procedures (e. For example, if arthrocentesis is performed on the shoulder and hip joint, the 20610 and 20610-59 modifiers can be coded Apr 3, 2025 · What are the billing guidelines for 20610? The procedure code (CPT code) 20610 or 20611 may be billed for the intraarticular injection. 20610 CPT Code Description Without ultrasound guidance, the 20610 CPT code is billed for a major joint or bursa The CPT 20610 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. Dec 1, 2020 · Laterality Matters When reporting codes for unilateral joint arthrocentesis, the use of modifier RT or LT on the injection procedure (e. Oct 17, 2025 · CPT code 20610 is considered one of the most common procedure codes in the orthopedic and pain management billing. CPT code 20552 is a key part of billing for these treatments. Oct 10, 2024 · Question: Are all injections that fall under the CPT code 20610 considered "intra-articular," or does that term not apply to ALL injections that can be performed under the 20610 CPT code, such as injections into the bursa? This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. The fact that they use the same CPT code does not mean they are duplicate billing for the same service as the physician. In this guide, we’ll explain what CPT code 20552 covers, how it’s used, and how The Auctus Group can help your practice with billing and coding for trigger point injections. The AMA, ADA, and AHA only permit the use of CPT, CDT, and NUBC/UB04 data in the Technical Specifications and Resource Manuals, and Value Set Directories, for the reporting of Medicaid and CHIP Core Set measures to CMS. CPT Code 20610 billing, pricing, and reimbursement details for administration code: Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance Aug 21, 2022 · Billing the injection procedure: The CPT® code (procedure code) 20610 or 20611 (with ultrasound guidance) may be billed for the intra-articular injection in addition to the drug. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. Here are the ICD-10 codes rheumatology practices frequently use: CPT 20610 - Arthrocentesis, aspiration and/or injection into, a major joint or bursa (eg, shoulder, hip, knee, or subacromial bursa); without ultrasound guidance Feb 6, 2025 · CPT code 96372 reports an injection that is administered intramuscularly or subcutaneously for therapeutic, prophylactic, or diagnostic purposes. CPT code 20610 is used for a procedure where a healthcare provider drains fluid from or injects medication into a joint or bursa without using ultrasound guidance. The process aids in alleviating pain in joints, decreasing inflammation, and enhancing the movement of patients with most musculoskeletal disorders. , Suite 39300, Chicago, IL 60611-5885. I can't find the LCD for 20600 or 20605 either. I go to check the LCD for 20610 and it is gone. Jun 7, 2025 · CPT Code 20610 is a commonly used medical billing code for arthrocentesis, aspiration, and/or injection procedures in large joints or bursae. One insurance company explained that the 20610 already Jul 13, 2022 · BILLING CODING KNEE INJECTION HYALGAN, SUPARTZ, VISCO, GENVISC, SYNVISC - J7325, J7321, J7328 20610 To all my blog readers that still are confused on how to properly bill, code and report these services. Dec 1, 2019 · Use this page to view details for the Local Coverage Article for Billing and Coding: Trigger Point Injections (TPI). LICENSE FOR USE OF PHYSICIANS’ CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION . Modifier RT, LT, 50, 59 and JW can be needed to report the 20610 CPT code properly. Learn how to bill the 20610 CPT code correctly, avoid denials, use proper modifiers, and understand Medicare and private payer reimbursement requirements. Nov 1, 1999 · A Medicare patient visits an orthopedic surgeons office for preoperative care that requires an injection. Use "EJ" modifier on drug codes to indicate subsequent injections of a series. Each type of injection, whether diagnostic or therapeutic, comes with specific codes that must be used correctly to avoid claim denials. Oct 17, 2024 · License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 N. Oct 1, 2015 · The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or 20611 to indicate if the service was performed unilaterally and modifier (50) must be appended to indicate if the service was performed bilaterally. Dec 4, 2024 · 20552 CPT Code: Everything You Need to Know Medical billing can get complicated, especially when it comes to procedures like trigger point injections. Jul 24, 2018 · Facility reimbursement is a completely separate payment process from physician, and compensates the facility for supplies, staff time, use of the space, etc. The doctor uses a Use official Procedure Price Lookup tool to compare national average to Medicare costs in ambulatory surgical centers, hosptial outpatient departments Jan 7, 2025 · CPT Code 20610 descriptions, usages, modifiers, places of service, and examples with pictures and content. When To Use CPT 20610 CPT code 20610 is used when a provider performs an arthrocentesis procedure involving aspiration or injection into a major joint or bursa without ultrasound guidance. CPT Code 20610 Medicare Reimbursement 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 denial was 1952 ( No valid LCD). The aspiration and/or injection procedure code may be billed in addition to the drug. Medicare does reimburse for CPT code 20611, which refers to the drainage or injection of a joint or bursa with ultrasound guidance. Do I code 20610-50 and double the charge and code J1040-50 and double the charge. The reimbursement rate for facility charges is $46. Both codes are used for intra-articular injections, which means the injection is delivered directly into the joint space. To get proper service reimbursement, healthcare providers, medical coders, and billing professionals must Jan 28, 2025 · CPT Code 20610 provides essential information for healthcare professionals on joint or bursa injection procedures, billing guidelines and more. 79 for 20610). If the drug was administered bilaterally, a -50 modifier should be used with Applies To: CPT© 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 Synvisc-One) and J7326 (Gel-One) Policy: When billing for CPT code 20605 (Drain/inj joint/bursa w/o us), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. I am so confused. I'm having issues with getting reimbursements billing this way. If not, -59. 76 and for non-facility charges $65. These procedures involve using a syringe or injection to perform arthrocentesis, aspiration, or injection of a major joint or bursa. It's important to verify the exact reimbursement rate with your local Tip: Always link a medically necessary ICD-10 code to procedures (e. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements. If the patient has any type of Medicare plan then use -XS. It symbolizes arthrocentesis; a procedure that entails the aspiration and/or injection of a major joint or a bursa. tc yycgo ezmuvx 8co jw 6c74 zk1 pg8 gib mkm7y