2025 CPT code 20704

Manual preparation and insertion of intra-articular drug delivery device(s).Report separately in addition to the primary procedure code.

This code is an add-on code and must be reported in addition to the primary procedure code. It should only be reported once per anatomical area per encounter.Manual preparation of the drug delivery device is a required component for the use of this code.

Modifiers 50 (bilateral procedure), 51 (multiple procedures), 59 (distinct procedural service), 76 (repeat procedure by the same physician), and 77 (repeat procedure by another physician) may be applicable depending on the circumstances of the case.Always refer to the CPT manual for accurate modifier application.

The medical necessity of code 20704 is established by the presence of a condition requiring localized, sustained drug delivery to a joint.Examples include post-operative infection prophylaxis following joint arthroplasty, treatment of septic arthritis, or management of severe inflammatory conditions such as rheumatoid arthritis. Appropriate documentation should support the clinical indication and the selection of this procedure over alternative treatment options.

The physician or qualified healthcare professional is responsible for the manual preparation of the drug delivery device and its insertion into the joint.This involves selecting the appropriate drug, mixing it with a carrier substance (if necessary), shaping the mixture into the delivery device, and precisely inserting the device into the target joint during the primary procedure.

IMPORTANT Codes 11981, 11982, and 11983 are used for pre-mixed, jarred, or boxed spacers with pre-infused drugs, where no manual mixing by the physician is required.For removal of the intra-articular drug delivery device, report +20705. For subfascial device insertion and removal, see +20700 and +20701 respectively. For intramedullary device insertion and removal, see +20702 and +20703 respectively. All these codes are add-on codes and must be reported in addition to a primary procedure code.

In simple words: The doctor prepares and inserts a special device into a joint to deliver medicine directly to the affected area. This is done as part of another, main procedure, and is billed separately.

This CPT code encompasses the manual preparation and insertion of a drug delivery device into a joint. The provider manually prepares the device (e.g., mixing antibiotics with a carrier substance) and then inserts it into the joint as part of a separately reported primary procedure.The device may be a microsphere, nanoparticle, or liposome system encapsulating a drug such as corticosteroids, DMARDs, or other anti-inflammatory medications. This procedure aims to provide sustained, localized drug delivery to treat conditions like osteoarthritis, rheumatoid arthritis flare-ups, synovitis, and joint pain.

Example 1: A patient undergoes a total knee arthroplasty (TKA). During the procedure, the surgeon uses code 20704 to insert an antibiotic-loaded polymethylmethacrylate (PMMA) bead delivery system into the knee joint to prevent post-operative infection., A patient presents with an infected knee arthroplasty requiring revision.The surgeon removes the infected prosthesis (27487), performs a thorough debridement, and inserts a new antibiotic-impregnated spacer using code 20704 to treat the infection., A patient with severe rheumatoid arthritis undergoes arthroscopy with synovectomy. The surgeon injects a corticosteroid-containing liposomal drug delivery system into the knee joint using code 20704 to manage inflammation and pain.

Detailed operative report specifying the type of drug delivery device used, the drug(s) contained, the method of preparation (manual mixing, if applicable), the location of insertion, and the indication for use.Preoperative and postoperative diagnostic imaging (x-ray, MRI) may be necessary to confirm placement and assess the efficacy of treatment.

** The parenthetical notes within the CPT code description are crucial for proper coding.These notes specify which primary procedures are compatible with code 20704 and highlight important distinctions from other codes.Ensure that you review these notes carefully and select the appropriate code based on the documentation provided.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.