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talk2us@finetunegums.com
#1 Posted : Monday, August 3, 2015 12:20:15 PM(UTC)
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talk2us@finetunegums.com

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It is my understanding that 20552 and 20553 are per session codes and not per injection codes. They cannot be billed with modifiers -50, -RT, or -LT, but J0585 can be bill on line two.

Would you please confirm or deny this?

Thank you
courtneydsnow
#2 Posted : Tuesday, August 4, 2015 3:02:58 PM(UTC)
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courtneydsnow

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Hi talk2us@finetunegums.com!

Great questions, the injection codes actually pertain to number of muscles instead of number of sessions or injections:

20552 = Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
20553 = Injection(s); single or multiple trigger point(s), 3 or more muscle(s)

Modifier -50 = Bilateral Procedure
Modifier -RT = Right Side
Modifier -LT = Left Side

I don't believe the use of these modifiers is generally required when billing medical insurers, but may not necessarily cause a denial if used either.

Here is a link to an sample medical policy for trigger point injections from Anthem BCBS:
https://www.anthem.com/medicalpolicies/guidelines/gl_pw_a051157.htm

If there is a particular insurer you're interested in seeing the medical policy for, I am happy to help if you have the name of the insurer handy :)

J0585 = Injection, onabotulinumtoxina, 1 unit

So this J code is actually related to botox injection

Hope this helps, please feel free to contact us with any further questions!
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