Each of the carrier’s three states (ID, NC and TN) have their own respective policies for these CPT codes including diagnosis requirements (see attached links). The most significant issue as far as billing of these services came about with the 2002 change in the CPT codes-especially for trigger point injections. Prior to January 1, 2002, each trigger point injected could be billed using CPT code 20550. After January 1, 2002, billing of trigger points switched from per injection to single or multiple injections per number of muscles (CPT code 20552 for single or multiple injections of one or two muscles vs. CPT code 20553 for single or multiple injections of three or more muscles). Also revised were codes for single or multiple injections tendon sheath or ligament (CPT code 20550) and tendon origin/insertion (CPT code 20551).
Since that time, we have noted that some providers who had been billing multiple trigger point injections along the spine have now moved to billing for multiple tendon origin/insertion codes – same locations/same beneficiaries (previously treated with trigger point injections). For these injections of tendon sheaths/origins/insertions to be medically necessary, there must be an inflammatory process in a given tendon (tendonitis) or tendon sheath tenosynovitis). Unless there is a systemic underlying illness (autoimmune or the like), the inflammation of multiple tendons, tendon sheaths, and muscle insertions – especially along the spine – should be extraordinarily rare.