M25.539 — Pain in unspecified wrist
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- In the narrative section of the claim form (Part A Loop 2300/NTE for EMC claims, or Form Locator 80 on the CMS 1450 form or paper claims, Part B Loop 2400/SV101-7 for EMC claims, or Item 19 on the CMS 1500 form for paper claims) please enter the following verbiage (without quotation marks) as it pertains to the respective tests.
- For Claims submitted prior to 1/1/2018 use the following guidance: 1. Zika rRT-PCR only – Use CPT® 87999 and enter “Zika PCR” ... 2. Trioplex rRT-PCR – Use CPT® 87999 and enter “Zika Trioplex”.
- Noridian retains the right to be sent a copy of the respective lab’s EUA upon request.
- 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.
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.
- Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
- 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 (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).
20 Active Policies
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
L39713 — Trigger Point Injections
J05
A59553 — Billing and Coding: Trigger Point Injections
J05
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
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