G44.201 — Tension-type headache, unspecified, intractable
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., name, dates of service), and be made available to the contractor upon request.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for the care and signed/dated office visit or operative report.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Key Coverage Criteria
- Trigger point injections (CPT 20552 or 20553) are covered when medically necessary to treat documented myofascial trigger points causing pain, with procedural documentation supporting medical necessity.
- CPT 20552 may be reported for trigger point injections involving 1 or 2 muscles; CPT 20553 may be reported for injections involving 3 or more muscles.
- The medication used for the injection must be billed on the same claim as the trigger point administration and reported with the appropriate HCPCS drug J-code or revenue code.
- Trigger point injections (CPT 20552, 20553) are covered when they meet the reasonable and necessary clinical requirements and frequency limitations of the referenced LCD L39656.
- Trigger point injections (TPIs) reported with CPT 20552 (1–2 muscles) or CPT 20553 (3+ muscles) are covered when determined medically reasonable and necessary per the applicable Local Coverage Determination (LCD).
- Only services that meet the LCD reasonable and necessary requirements and frequency limitations are considered covered; billing of TPIs must follow CPT coding guidance in the AMA CPT manual.
17 Active Policies
A59553 — Billing and Coding: Trigger Point Injections
J05
L39713 — Trigger Point Injections
J05
A59487 — Billing and Coding: Trigger Point Injections (TPI)
J06
L39662 — Trigger Point Injections (TPI)
J06
ANTHEM-CG-MED-97 — CG-MED-97 Biofeedback and Neurofeedback
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.