General Guidelines for claims submitted to or Part A or Part B MAC:

Claims for the injection of collagenase clostridium histolyticum should be submitted with CPT code 20550. CPT code 20550 should be reported once per cord injected regardless of how many injections per session. For the initial evaluation and injection, the appropriate E&M code (with modifier 25) may be submitted with the injection code. If the injection is performed subsequent to the initial evaluation, no E&M code should be submitted with the injection code. The finger extension manipulation performed the day after injection should be billed with CPT code 26989. CPT code 26989 includes the manipulation and should be billed once regardless of the number of manipulations performed on this day. CPT code 26989 also includes the use of local anesthesia, if required. “Stretching of cord” or “manipulation of cord” should be notated in Item 19 of the CMS-1500 claim form or the electronic equivalent for the Part B MAC.

CPT code 29130 may also be submitted for splint application.

Reimbursement Guidelines

UnitedHealthcare Community Plan reimburses for injections into the tendon/tendon sheath, or ligament (CPT codes 20550, 20551) ganglion cyst (CPT code 20612), carpal tunnel or tarsal tunnel (CPT code 20526) when one of the diagnosis codes are listed on a claim denoting problems with one of these regions. UnitedHealthcare Community Plan will not reimburse when the treatment rendered is without inclusion of one of the (ICD-9-CM and ICD-10-CM) diagnostic codes being included on the claim accurately reflecting the member’s condition.

The attached procedure to diagnosis list was first derived by identifying areas of convergence across Center for Medicare and Medicaid Services (CMS) Local Coverage Determinations (LCD). The LCD policies were then submitted to various specialty societies for comment.
CPT code section

20526 Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel

20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)

20551 Injection(s); single tendon origin/insertion

20612 Aspiration and/or injection of ganglion cyst(s) any location

Morton’s neuromas injections do not involve the structures described by CPT codes 20550 and 20551 or direct injection into other peripheral nerves but rather the injection of tissue surrounding a specific focus of inflammation on the foot. These therapies are not to be coded using CPT codes 20550, 20551, 64450, or 64640. Most specifically, the provider must not bill CPT codes 64450 or 64640 for these injections, since those codes respectively address the additional work of an injection of an anesthetic agent nerve block), neurolytic or sclerosing agent into relatively more difficult peripheral nerves, rather than that involved in an injection of relatively easily localized areas.

Injections for plantar fasciitis are billed with CPT code 20550 and ICD-9-CM 728.71. Injections for calcaneal spurs are billed as other tendon origin/insertions with CPT code 20551.

Effective 11/15/2010 and after Providers are instructed to bill CPT code 20550 [Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar “fascia”)], in addition to the drug. Prior to 11/15/2010 providers were instructed to bill CPT code 26989 (Unlisted procedure, hands or fingers).

Injections of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels and Morton’s Neuroma (CPT codes 20526, 20550, 20551, 20612 & 28899)

Medicare does not have a National Coverage Determination (NCD) for the specific types of injections for pain listed above.

? Local Coverage Determinations (LCDs) which address these injections exist and compliance with these LCDs is required where applicable. For state-specific LCD, refer to the LCD Availability Grid (Attachment G).