Billing and Coding: Trigger Point Injections (TPI)

Trigger point injections (CPT 20552 for 1–2 muscles; CPT 20553 for 3+ muscles) are covered when medically necessary and supported by detailed documentation of trigger point locations, muscles injected, medication name/units, and immediate pre-/post-injection percent pain relief. Coverage is limited to no more than three TPI sessions in a rolling 12 months; do not bill separate codes for multiple injections into the same muscle, do not bill anesthesia codes or modifier 50 with these CPTs, and avoid non–FDA-approved biological injectants (which may cause claim denial). Medications must be billed on the same claim with appropriate J-codes (unclassified J-codes require drug name/dosage in Box 19), and full, signed, legible medical records supporting ICD-10 selection and medical necessity are required.

"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 injec..."