Billing and Coding: Trigger Point Injections

Trigger point injections are covered when they meet the reasonable and necessary requirements in LCD L37913; documentation must clearly support diagnosis, procedure, injectant name/units, locations treated, and immediate percent pain relief. Limitations include a maximum of 3 sessions in a rolling 12 months, CPT 20552 for 1–2 muscles and 20553 for 3+ muscles (individual injections into a muscle are not billed separately), prohibition of anesthesia codes with 20552/20553, and potential denial for use of non–FDA-approved biological injectants. Claims must include the drug on the same claim with appropriate J- or revenue codes and unclassified J-codes must list drug name/dosage in Box 19 (C9399 restricted to facility claims).

"Trigger point injections are covered only when they meet the reasonable and necessary requirements in the related LCD L37913."

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