Coding for Trigger Point Injections:
"Trigger points are described as hyper irritable spots in skeletal
muscle that are associated with palpable nodules in taut bands of
muscle fibers. Trigger point researchers believe that palpable
nodules are small contraction knots and a common cause of pain."
What Causes Trigger Points? It could be due to or but not
Injuries (e.g. whiplash)
Daily activities (especially of that are work-related) of repetitive
movements (e.g. typing, data entry)
Lack of exercise, stress and poor posture
Lack of activity
Poor back support
Poor sleeping position
The trigger point codes are very specific and only has two codes.
- 20552 - Injection(s); single or multiple trigger point(s), one
or two muscles
- 20553 - Single or multiple trigger points(s), three or more
Global Days: 0
*** Imaging/Radiology Crosscodes:
76942 Ultrasonic guidance for needle placement (eg, biopsy,
aspiration, injection, localization device), imaging supervision and
77002 Fluoroscopic guidance for needle placement (eg, biopsy,
aspiration, injection, localization device)
Trigger point injections must be billed one line regardless how many
injections. For instance, if your pain doc performed trigger points on
2 muscles, report 20552 x 1 unit... (not 2 units for 2 muscles!)
CPT 20553 is NOT an add-on code!
Modifier -59 should not be used with these codes.
Modifier –25 can be appended for E/M office visit if done on the
same day and such is separate and identifiable medically necessary.
Above and Beyond.
Documentation in the patient’s medical record should include proper
evaluation leading to the diagnosis of the trigger points, specific
identification of the affected muscle(s). It must also be properly
documented the reason why injections are the chosen as a
Here's a part of AMA's Question and Answer Per CPT Assistant
Question: “My physician performed two trigger point injections in
two different muscles. Would it be appropriate to report code 20552
twice for the two injections?”
AMA Comment: “Code 20552-20553 are reported one time per
session, regardless of the number of injections or muscles injected.
Therefore, it would not be appropriate to report code 20552, Injection
(s); single or multiple trigger point(s), one or two muscle(s) twice for
the two injections administered.”
**** CPT is owned by the American Medical Association (AMA)
**** For more references: Consult your CPT code books. The
National Correct Coding Initiative (NCCI) and third pary payer
payment policies and guidelines
**** CPT Assistant September 2003
**** Always refer to your local carrier's LCDs
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