Wiki TRIGGER POINT INJECTIONS

[vinnie329@yahoo.com]

Can anyone help me with billing out Trigger Point Injections for SI joint/Lumbar for Medicare? 20552 is what we are using for single trigger point injections with NO modifiers (I read that MDB does not like modifiers on this code) and we are still getting denials. We are not billing more than 3 times in a 90 day period, and for the most part it's only 1 time a year. We continuely get 20552 denied through MDB claiming it is "not medically necessary". They deny the ICD 10 codes for Sacroilitis and so we use the DX code for Lumbar Enthesopathy M46.06. Regardless of how we try to bill this it continutely gets denied and we cannot find a reason why. Any help is greatly appreciated.
Thank you!

 

[bonedocs2]

You need to use Myalgia, as the dx per the Medicare LCD. (A57702) That is if that is supported in your documentation.

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57702

 

[jkyles]

Can anyone help me with billing out Trigger Point Injections for SI joint/Lumbar for Medicare? 20552 is what we are using for single trigger point injections with NO modifiers (I read that MDB does not like modifiers on this code) and we are still getting denials. We are not billing more than 3 times in a 90 day period, and for the most part it's only 1 time a year. We continuely get 20552 denied through MDB claiming it is "not medically necessary". They deny the ICD 10 codes for Sacroilitis and so we use the DX code for Lumbar Enthesopathy M46.06. Regardless of how we try to bill this it continutely gets denied and we cannot find a reason why. Any help is greatly appreciated.
Thank you!

Hi there, have you reviewed your carrier's current LCD and companion billing/coding article for trigger point injections?

Five MACs issued a uniform LCD last year that created a number of coverage limits for trigger points, including the covered diagnosis codes. You might be in a situation where the patient has to pay out of pocket, unfortunately.

diagnosis codes, diagnosis coding

 

[vinnie329@yahoo.com]

Wonderful! Appreciate the feedback

diagnosis codes, diagnosis coding

 

[lscullin]

2025 Alaska codes covered current LCD. Sad​

Group 1​

(10 Codes)

Group 1 Paragraph
N/A
Group 1 Codes

Code	Description
G44.201	Tension-type headache, unspecified, intractable
G44.209	Tension-type headache, unspecified, not intractable
G44.211	Episodic tension-type headache, intractable
G44.219	Episodic tension-type headache, not intractable
G44.221	Chronic tension-type headache, intractable
G44.229	Chronic tension-type headache, not intractable
M79.10	Myalgia, unspecified site
M79.11	Myalgia of mastication muscle
M79.12	Myalgia of auxiliary muscles, head and neck
M79.18*	Myalgia, other site

diagnosis codes, diagnosis coding

 

[jkyles]

Yes, that's consistent across the five MACs that adopted the uniform LCD.

diagnosis codes, diagnosis coding

 

[hnfbernard@gmail.com]

Re the LCD we've found carriers only pay for M79.18 despite M79.10 also being on the LCD. So we exclusively use M79.18

diagnosis codes, diagnosis coding