CPT code 20551 is for an injection into the tendon origin or insertion, commonly used for treating tendon-related issues.
CPT code 20551 is used for an injection procedure at the origin or insertion point of a tendon. This code is typically utilized when a healthcare provider administers a therapeutic substance, such as a corticosteroid, directly into the area where a tendon attaches to a bone, often to relieve pain or inflammation.
For CPT code 20551 (Injection(s); single tendon origin/insertion), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: Used if the injection is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that the injection is distinct or independent from other services performed on the same day.
4. Modifier RT - Right Side: Indicates that the injection was performed on the right side of the body.
5. Modifier LT - Left Side: Indicates that the injection was performed on the left side of the body.
6. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 22 - Increased Procedural Services: Applied if the procedure required significantly more work than usual.
11. Modifier 23 - Unusual Anesthesia: Used if general anesthesia is required for a procedure that typically does not require it.
12. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used if an unrelated evaluation and management service is provided during the postoperative period.
13. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Used if a significant, separately identifiable evaluation and management service is provided on the same day as the procedure.
14. Modifier 26 - Professional Component: Used if only the professional component of the service is being billed.
15. Modifier 32 - Mandated Services: Used if the service is mandated by a third party, such as an insurance company or government agency.
16. Modifier 52 - Reduced Services: Used if the service provided is less than usually required.
17. Modifier 53 - Discontinued Procedure: Used if the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
18. Modifier 54 - Surgical Care Only: Used if only the surgical care portion of the service is being billed.
19. Modifier 55 - Postoperative Management Only: Used if only the postoperative management portion of the service is being billed.
20. Modifier 56 - Preoperative Management Only: Used if only the preoperative management portion of the service is being billed.
21. Modifier 62 - Two Surgeons: Used if two surgeons are required to perform the procedure.
22. Modifier 66 - Surgical Team: Used if a surgical team is required to perform the procedure.
23. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return for a related procedure during the postoperative period.
24. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare does reimburse for CPT code 20551, which is used for an injection into the tendon origin or insertion. The reimbursement amount can vary based on geographic location and other factors such as the specific Medicare Administrative Contractor (MAC) policies. As of the latest available data, the national average reimbursement rate for CPT code 20551 is approximately $60 to $80. However, it is essential to verify the exact reimbursement rate with your local MAC or through the Medicare Physician Fee Schedule (MPFS) for the most accurate and up-to-date information.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 20551 for tendon origin/insertion injections. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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