M25.519 — Pain in unspecified shoulder
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- The article provides billing and coding guidance and references LCD L39116; required documentation (e.g., medical records, prior authorization, specific forms) is not specified here and must be obtained from LCD L39116.
- Billing, coding, and documentation requirements (e.g., required medical record elements, coding guidance, prior authorization if applicable) are specified in LCD L39139 and accompanying billing guidance; review LCD L39139 for the exact documentation required for claims.
- This billing and coding article provides billing and coding guidance for Local Coverage Determination (LCD) L39575 regarding amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications.
- Full coverage, limitation, and documentation criteria are defined in LCD L39575; the source policy text was not provided in this request.
Key Coverage Criteria
- No specific clinical indications are provided in this billing and coding article; coverage criteria for amniotic and placental-derived product injections/applications for musculoskeletal non-wound indications are described in Local Coverage Determination L39116.
- Coverage for amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications is determined by Local Coverage Determination L39139; consult LCD L39139 for specific clinical indications and thresholds.
- 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.
- Trigger point injections (TPIs) using CPT 20552 (1–2 muscles) or CPT 20553 (3+ muscles) are covered when medically necessary and supported by documentation of trigger point locations, muscles injected, medication name and units, and immediate pre- and post-injection percent pain relief.
20 Active Policies
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
A59553 — Billing and Coding: Trigger Point Injections
J05
L39713 — Trigger Point Injections
J05
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