LCD Reference Article Billing and Coding Article

Billing and Coding: Injection of Trigger Points

A57114

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57114
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Injection of Trigger Points
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33912, Injection of Trigger Points. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidelines

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. The medical record must clearly indicate the number of injections given per session and the site(s) injected. Furthermore, the medical record must clearly document the medical necessity for repeated injections of trigger point(s). When frequent injections are required, the medical record must reflect the reason for repeated injections.

Response To Comments

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1
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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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N/A

CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(213 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide limited coverage for CPT codes: 20552 and 20553.

Group 1 Codes
Code Description
D48.19 Other specified neoplasm of uncertain behavior of connective and other soft tissue
M25.721 Osteophyte, right elbow
M25.722 Osteophyte, left elbow
M25.751 Osteophyte, right hip
M25.752 Osteophyte, left hip
M25.771 Osteophyte, right ankle
M25.772 Osteophyte, left ankle
M25.774 Osteophyte, right foot
M25.775 Osteophyte, left foot
M35.4 Diffuse (eosinophilic) fasciitis
M46.00 Spinal enthesopathy, site unspecified
M46.01 Spinal enthesopathy, occipito-atlanto-axial region
M46.02 Spinal enthesopathy, cervical region
M46.03 Spinal enthesopathy, cervicothoracic region
M46.04 Spinal enthesopathy, thoracic region
M46.05 Spinal enthesopathy, thoracolumbar region
M46.06 Spinal enthesopathy, lumbar region
M46.07 Spinal enthesopathy, lumbosacral region
M46.08 Spinal enthesopathy, sacral and sacrococcygeal region
M46.09 Spinal enthesopathy, multiple sites in spine
M53.82 Other specified dorsopathies, cervical region
M54.03 Panniculitis affecting regions of neck and back, cervicothoracic region
M54.04 Panniculitis affecting regions of neck and back, thoracic region
M54.05 Panniculitis affecting regions of neck and back, thoracolumbar region
M54.06 Panniculitis affecting regions of neck and back, lumbar region
M54.07 Panniculitis affecting regions of neck and back, lumbosacral region
M54.08 Panniculitis affecting regions of neck and back, sacral and sacrococcygeal region
M54.09 Panniculitis affecting regions, neck and back, multiple sites in spine
M54.89 Other dorsalgia
M60.10 Interstitial myositis of unspecified site
M60.111 Interstitial myositis, right shoulder
M60.112 Interstitial myositis, left shoulder
M60.121 Interstitial myositis, right upper arm
M60.122 Interstitial myositis, left upper arm
M60.131 Interstitial myositis, right forearm
M60.132 Interstitial myositis, left forearm
M60.141 Interstitial myositis, right hand
M60.142 Interstitial myositis, left hand
M60.151 Interstitial myositis, right thigh
M60.152 Interstitial myositis, left thigh
M60.161 Interstitial myositis, right lower leg
M60.162 Interstitial myositis, left lower leg
M60.171 Interstitial myositis, right ankle and foot
M60.172 Interstitial myositis, left ankle and foot
M60.18 Interstitial myositis, other site
M60.19 Interstitial myositis, multiple sites
M60.80 Other myositis, unspecified site
M60.811 Other myositis, right shoulder
M60.812 Other myositis, left shoulder
M60.821 Other myositis, right upper arm
M60.822 Other myositis, left upper arm
M60.831 Other myositis, right forearm
M60.832 Other myositis, left forearm
M60.841 Other myositis, right hand
M60.842 Other myositis, left hand
M60.851 Other myositis, right thigh
M60.852 Other myositis, left thigh
M60.861 Other myositis, right lower leg
M60.862 Other myositis, left lower leg
M60.871 Other myositis, right ankle and foot
M60.872 Other myositis, left ankle and foot
M60.88 Other myositis, other site
M60.89 Other myositis, multiple sites
M62.211 Nontraumatic ischemic infarction of muscle, right shoulder
M62.212 Nontraumatic ischemic infarction of muscle, left shoulder
M62.221 Nontraumatic ischemic infarction of muscle, right upper arm
M62.222 Nontraumatic ischemic infarction of muscle, left upper arm
M62.231 Nontraumatic ischemic infarction of muscle, right forearm
M62.232 Nontraumatic ischemic infarction of muscle, left forearm
M62.241 Nontraumatic ischemic infarction of muscle, right hand
M62.242 Nontraumatic ischemic infarction of muscle, left hand
M62.251 Nontraumatic ischemic infarction of muscle, right thigh
M62.252 Nontraumatic ischemic infarction of muscle, left thigh
M62.261 Nontraumatic ischemic infarction of muscle, right lower leg
M62.262 Nontraumatic ischemic infarction of muscle, left lower leg
M62.271 Nontraumatic ischemic infarction of muscle, right ankle and foot
M62.272 Nontraumatic ischemic infarction of muscle, left ankle and foot
M62.28 Nontraumatic ischemic infarction of muscle, other site
M62.411 Contracture of muscle, right shoulder
M62.412 Contracture of muscle, left shoulder
M62.421 Contracture of muscle, right upper arm
M62.422 Contracture of muscle, left upper arm
M62.431 Contracture of muscle, right forearm
M62.432 Contracture of muscle, left forearm
M62.441 Contracture of muscle, right hand
M62.442 Contracture of muscle, left hand
M62.451 Contracture of muscle, right thigh
M62.452 Contracture of muscle, left thigh
M62.461 Contracture of muscle, right lower leg
M62.462 Contracture of muscle, left lower leg
M62.471 Contracture of muscle, right ankle and foot
M62.472 Contracture of muscle, left ankle and foot
M62.48 Contracture of muscle, other site
M62.49 Contracture of muscle, multiple sites
M62.830 Muscle spasm of back
M62.831 Muscle spasm of calf
M62.838 Other muscle spasm
M62.84 Sarcopenia
M62.89 Other specified disorders of muscle
M65.111 Other infective (teno)synovitis, right shoulder
M65.112 Other infective (teno)synovitis, left shoulder
M65.121 Other infective (teno)synovitis, right elbow
M65.122 Other infective (teno)synovitis, left elbow
M65.131 Other infective (teno)synovitis, right wrist
M65.132 Other infective (teno)synovitis, left wrist
M65.141 Other infective (teno)synovitis, right hand
M65.142 Other infective (teno)synovitis, left hand
M65.151 Other infective (teno)synovitis, right hip
M65.152 Other infective (teno)synovitis, left hip
M65.161 Other infective (teno)synovitis, right knee
M65.162 Other infective (teno)synovitis, left knee
M65.171 Other infective (teno)synovitis, right ankle and foot
M65.172 Other infective (teno)synovitis, left ankle and foot
M65.18 Other infective (teno)synovitis, other site
M65.19 Other infective (teno)synovitis, multiple sites
M65.311 Trigger thumb, right thumb
M65.312 Trigger thumb, left thumb
M65.321 Trigger finger, right index finger
M65.322 Trigger finger, left index finger
M65.331 Trigger finger, right middle finger
M65.332 Trigger finger, left middle finger
M65.341 Trigger finger, right ring finger
M65.342 Trigger finger, left ring finger
M65.351 Trigger finger, right little finger
M65.352 Trigger finger, left little finger
M65.4 Radial styloid tenosynovitis [de Quervain]
M65.831 Other synovitis and tenosynovitis, right forearm
M65.832 Other synovitis and tenosynovitis, left forearm
M65.841 Other synovitis and tenosynovitis, right hand
M65.842 Other synovitis and tenosynovitis, left hand
M65.871 Other synovitis and tenosynovitis, right ankle and foot
M65.872 Other synovitis and tenosynovitis, left ankle and foot
M65.88 Other synovitis and tenosynovitis, other site
M65.89 Other synovitis and tenosynovitis, multiple sites
M67.311 Transient synovitis, right shoulder
M67.312 Transient synovitis, left shoulder
M67.321 Transient synovitis, right elbow
M67.322 Transient synovitis, left elbow
M67.331 Transient synovitis, right wrist
M67.332 Transient synovitis, left wrist
M67.341 Transient synovitis, right hand
M67.342 Transient synovitis, left hand
M67.351 Transient synovitis, right hip
M67.352 Transient synovitis, left hip
M67.361 Transient synovitis, right knee
M67.362 Transient synovitis, left knee
M67.371 Transient synovitis, right ankle and foot
M67.372 Transient synovitis, left ankle and foot
M67.38 Transient synovitis, other site
M67.39 Transient synovitis, multiple sites
M70.21 Olecranon bursitis, right elbow
M70.22 Olecranon bursitis, left elbow
M70.31 Other bursitis of elbow, right elbow
M70.32 Other bursitis of elbow, left elbow
M70.61 Trochanteric bursitis, right hip
M70.62 Trochanteric bursitis, left hip
M70.71 Other bursitis of hip, right hip
M70.72 Other bursitis of hip, left hip
M72.8 Other fibroblastic disorders
M75.81 Other shoulder lesions, right shoulder
M75.82 Other shoulder lesions, left shoulder
M76.01 Gluteal tendinitis, right hip
M76.02 Gluteal tendinitis, left hip
M76.11 Psoas tendinitis, right hip
M76.12 Psoas tendinitis, left hip
M76.21 Iliac crest spur, right hip
M76.22 Iliac crest spur, left hip
M76.31 Iliotibial band syndrome, right leg
M76.32 Iliotibial band syndrome, left leg
M76.61 Achilles tendinitis, right leg
M76.62 Achilles tendinitis, left leg
M76.71 Peroneal tendinitis, right leg
M76.72 Peroneal tendinitis, left leg
M76.811 Anterior tibial syndrome, right leg
M76.812 Anterior tibial syndrome, left leg
M76.821 Posterior tibial tendinitis, right leg
M76.822 Posterior tibial tendinitis, left leg
M76.899 Other specified enthesopathies of unspecified lower limb, excluding foot
M77.01 Medial epicondylitis, right elbow
M77.02 Medial epicondylitis, left elbow
M77.11 Lateral epicondylitis, right elbow
M77.12 Lateral epicondylitis, left elbow
M77.31 Calcaneal spur, right foot
M77.32 Calcaneal spur, left foot
M77.41 Metatarsalgia, right foot
M77.42 Metatarsalgia, left foot
M77.51 Other enthesopathy of right foot and ankle
M77.52 Other enthesopathy of left foot and ankle
M77.9 Enthesopathy, unspecified
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
M79.601 Pain in right arm
M79.602 Pain in left arm
M79.604 Pain in right leg
M79.605 Pain in left leg
M79.621 Pain in right upper arm
M79.622 Pain in left upper arm
M79.631 Pain in right forearm
M79.632 Pain in left forearm
M79.641 Pain in right hand
M79.642 Pain in left hand
M79.644 Pain in right finger(s)
M79.645 Pain in left finger(s)
M79.651 Pain in right thigh
M79.652 Pain in left thigh
M79.661 Pain in right lower leg
M79.662 Pain in left lower leg
M79.671 Pain in right foot
M79.672 Pain in left foot
M79.674 Pain in right toe(s)
M79.675 Pain in left toe(s)
M79.7 Fibromyalgia
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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N/A

Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R1

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Update. The following ICD-10 code has been deleted from Group 1 codes: D48.1. The following ICD-10 code has been added to Group 1 codes: D48.19. Minor formatting changes have been made throughout the article. Reference added for Social Security Act (Title XVIII), Section 1833(e).

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33912 - Injection of Trigger Points
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Rules and Regulations URLs
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Public Versions
Updated On Effective Dates Status
10/20/2023 10/01/2023 - N/A Currently in Effect You are here
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