Billing and Coding: Pain Management - injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels

Medicare covers injections into tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels when medically necessary and documented, including diagnostic injections (up to two, spaced ≥1 week apart) and therapeutic injections following proven diagnostic benefit. Therapeutic injections should generally be spaced ≥2 months, limited to about four per year for most patients, and require detailed procedure notes, documentation of drug/dose, and adherence to billing/modifier rules (e.g., RT/LT for bilaterals, do not use modifier 50 with CPT 20551/20612).

"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 cl..."

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