28899
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- For multiple injection sites, the record must document the reason for injecting each site and substantiate that all injections were reasonable and necessary.
- The medical record must document medical necessity including relevant history, physical exam, and results of pertinent diagnostic tests or procedures supporting the indication for the injection.
- The procedure note must be legible and include techniques used, site(s) of injection, drugs with doses/volumes/concentrations, and pre- and post-procedural pain assessments.
- When a referring/ordering physician is required, the referring/ordering physician's name and NPI must be reported on the claim; claims without a valid ICD-10-CM diagnosis code will be returned as incomplete.
Key Coverage Criteria
- Injection into tendon sheaths, ligaments, ganglion cysts, carpal tunnel, or tarsal tunnel is covered when medically necessary to diagnose or treat local pain and the medical record documents the clinical reason for the injection at each site.
- Diagnostic injections to identify a painful structure are covered when performed no sooner than one week (preferably two) apart and limited to no more than two injections in the diagnostic phase.
- Therapeutic injections are covered when a patient had diagnostic injections demonstrating initial pain relief of ≥75–100% with return of function and maintains ≥50% pain relief and functional improvement for at least six weeks.
- 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.
18 Active Policies
L33622 — Pain Management - Injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels
J06
A52863 — Billing and Coding: Pain Management - injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels
J06
L34218 — Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
UHC-POL-surgery-foot — Surgery of the Foot
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