2025 CPT code 20553
(Active) Effective Date: N/A Revision Date: N/A Surgery - Injection(s) Musculoskeletal System Feed
Injection(s); single or multiple trigger point(s), 3 or more muscles.
Modifiers may be applicable depending on the circumstances of the service.Consult the CPT manual and payer specific guidelines for appropriate modifier usage.
Medical necessity is established through documentation of a proper diagnosis linking the patient's symptoms to the need for trigger point injections. This typically involves a thorough history and physical examination, including assessment of referred pain and twitch responses.Frequency limitations may apply; some payers limit the number of trigger point injections within a defined period (e.g., 3 injections within a 90-day period).
The physician or qualified healthcare professional is responsible for locating and injecting trigger points into the affected muscles.This includes palpating the muscles, assessing for referred pain and twitch response, and administering the injection.
In simple words: This code covers injections to relieve muscle pain.A doctor injects medicine into three or more different muscles to treat painful knots or areas in the muscles. The doctor feels the muscles to find the problem areas before injecting the medicine.
CPT code 20553, Injections; single or multiple trigger points; three or more muscles, encompasses the injection of anesthetic or corticosteroid substances into three or more muscles to alleviate painful trigger points.The procedure involves palpating muscles to locate trigger points, assessing for referred pain and twitch response, and then injecting the medication into each identified trigger point.The number of injections per muscle is not separately billed; the code represents a single unit of service regardless of the injection count per muscle, and only one code (20552 or 20553) should be reported per day.This code should not be used in conjunction with codes 20560 or 20561 for the same muscles, and no anesthesia codes should be billed alongside it.If imaging guidance is used, report codes 76942, 77002, or 77021 separately.
Example 1: A patient presents with chronic neck pain due to trigger points in the trapezius, levator scapulae, and sternocleidomastoid muscles. The physician performs trigger point injections into all three muscles. Code 20553 is reported., A patient reports myofascial pain in the lower back.The physician identifies and injects trigger points in the quadratus lumborum, erector spinae, and gluteus medius muscles. Code 20553 is reported., A patient experiences pain in the shoulder region.The physician identifies and treats trigger points in the supraspinatus, infraspinatus, and teres minor muscles with injections. Code 20553 is reported.
Complete medical record with patient identification, diagnosis supporting medical necessity, detailed description of muscles injected, amount and type of medication administered, and documentation of the examination findings (palpation, referred pain, twitch response).
** The number of injections performed within each muscle does not affect coding.The medication injected should be reported on the claim using HCPCS J-codes or other relevant codes.Billing for trigger point injections may be subject to medical necessity and frequency limitations imposed by payers.
- Revenue Code: P6B (Minor Procedures - Musculoskeletal)
- RVU: Information not provided.RVUs vary based on geographic location, practice expense, and other factors. Consult your local Medicare Administrative Contractor (MAC) or other payer's fee schedule for current RVU values.
- Global Days: Not applicable. This is a single procedure code, not a global procedure.
- Payment Status: Active
- Modifier TC rule: Modifier TC (Technical Component) does not apply to this code.
- Fee Schedule: Information not provided. Consult your local Medicare Administrative Contractor (MAC) or other payer's fee schedule for historical fee information.
- Specialties:Pain Management, Anesthesiology, Physical Medicine and Rehabilitation, Orthopedics
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, other locations as determined by payer rules.