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Modifier for trigger point injection 20553, 20552

9/22/2020

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One of our blog readers asked why their claim for Trigger Point injection is being denied due to missing modifier.
MODIFIER FOR TRIGGER POINT INJECTION CPT Code 20553 CPT Code 20552

​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!
MODIFIER FOR TRIGGER POINT INJECTION CPT Code 20553 CPT Code 20552

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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    Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.

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