Billing and Coding: Trigger Point Injections (TPI)

Trigger point injections (CPT 20552, 20553) are covered when they meet the reasonable and necessary clinical criteria and frequency limits of LCD L39656; documentation must support the ICD-10 and CPT/HCPCS codes. Coverage is limited to a maximum of three TPI sessions in a rolling 12-month period, CPT 20552 is for 1–2 muscles and 20553 is for ≥3 muscles, and the code includes all injections into the muscle; biologic/non–FDA-approved injectants may lead to claim denial and anesthesia or modifier 50 should not be billed with these CPTs.

"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."

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