Modifier for trigger point injection 20553, 20552

One of our blog readers asked why their claim for Trigger Point injection is being denied due to missing modifier.

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​Let's describe these 2 Trigger point injection codes:
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 muscles

Widely indicated for Myofascial Pain.

Key point to remember! - these 2 CPT Codes 20552, 20553 DO NOT NEED A MODIFIER!

Denial Reasons for Trigger Point Injection CPT 20553

Denials Reasons for Trigger Point Injection CPT 20552, 20553 and what you should be looking for:

• The lack of medical necessity (have you checked the payer clinical policy and guideline?)
• When billing with an E/M Evaluation and Management (you will need a modifier on the E/M but not on the Trigger Point Injection CPT code;
• When being performed with another procedure being "distinct" (look at your modifier 59);
• When being performed with other "multiple" and or "reduced" procedures (look at your modifier 51, 52);
• Missing drug name used;
• Missing NDC number for the drug used;

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