Does 20527 require prior authorization?

No, 20527 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 20527?

Medicare facility rate: $58.45. Non-facility rate: $94.19. Work RVU: 0.98.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.98

Facility

$58.45

Non-Facility

$94.19

The clinical record must document the elements leading to the diagnosis and the treatment decision to use injection (history, exam findings, diagnostic rationale).
Records must be made available upon request to support coding and medical necessity determinations.
Clinical records must document justification for injections beyond three to the same site within six months, including reason for prior therapy failure and why further treatment is expected to succeed.
Documentation that diagnosis has been confirmed is required before use of sclerosing or neurolytic agents for longer-term management.

Injection therapy for Morton's neuroma (focal injection of tissue surrounding a localized plantar digital inflammatory focus) should be billed using CPT 64455 or 64632.
Injection therapy for plantar fasciitis is addressed and billed with CPT 20550 and corresponds to ICD-10-CM M72.2.
Injection to tendons at their origin or insertion sites should be reported using CPT 20551.
A single CPT 20551 should be reported when injections include both the plantar fascia and the area around a calcaneal spur.
Injection of chemical agents (local anesthetics, steroids, sclerosing agents, or neurolytic agents) into ganglion cysts, tendon sheaths, tendon origins/insertions, ligaments, or near nerves of the foot (including Morton's neuroma and its intermetatarsal variants) is indicated to relieve pain or dysfunction from inflammation or other pathological changes.
Injection into the carpal tunnel or tarsal tunnel is indicated for patients with mild carpal tunnel syndrome or mild tarsal tunnel syndrome, with or without a trial of conservative measures (e.g., NSAIDs, orthoses).

A57079 — Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma

L34218 — Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma

UHC-POL-xiaflex — Xiaflex (Collagenase Clostridium Histolyticum)

UMR-POL-UMR-xiaflex — Xiaflex (Collagenase Clostridium Histolyticum)

SUREST-POL-SUREST-xiaflex — Xiaflex (Collagenase Clostridium Histolyticum)

Ask Verity about documentation requirements, denial risks, or coverage in your state.