Pain Management - Trigger Point Injections - CPT codes 20552 and 20553

Date Issued: 12/14/2016

Effective March 1, 2017, Any combination of trigger point injections, CPT codes 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) and 20553 (Injection(s); single or multiple trigger point(s), 3 or more muscles), when billed >3 times in a 90-day period, for the same anatomic site, without medical necessity, will be denied.

Only one code from 20552 or 20553 should be reported on any particular day, no matter how many sites or regions are injected. When a given site is injected, it will be considered one injection service, regardless of the number of injections administered.

EmblemHealth considers, injections used on a routine basis (e.g., on a regular periodic and continuous basis, for patients with chronic non-malignant pain syndromes) are not considered medically necessary. Dry needle trigger point injections are not considered medically necessary, as there is insufficient evidence of therapeutic value. Injections consisting of only saline and/or botanical substances are not supported in the peer-reviewed literature and are not considered medically necessary. Only injections of local anesthetics and corticosteroids are covered. To learn more about these changes, visit our Pain Management policy on our Medical Policies webpage.