Payment should be made for needling of a bursa, including an adventitious bursa, under the appropriate arthrocentesis code. This includes injection of carpal tunnel, heel spur, ganglion cyst and Baker's cyst. Arthrocentesis or needling of bursa performed in connection with the fingers or toes, e.g., interphalangeal, metacarpal-phalangeal or metatarsal-phalangeal joints, should be reported under procedure code 20600.

Services performed in connection with the hand, foot, wrist (carpal tunnel) or ankle, e.g., carpal-metacarpal, tarsal-metatarsal, carpal or tarsal joints including the heel (heel spur) should be reported under procedure code 20605.

Claims reporting arthrocentesis or injection of the sacroiliac joint should be reported and paid under procedure code 20610.

Arthrocentesis reported for other areas of the spine, i.e., cervical, dorsal, lumbar, lumbosacral or coccyx should be processed as injection of trigger points (procedure codes 20552, and 20553).  However, when a doctor reports his services as arthrocentesis by fluoroscopy, the service should be processed under the appropriate procedure code for arthrocentesis of the type joint involved. Itemized charges should be combined and processed under the appropriate arthrocentesis code.  Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day.  When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines.

Except for local anesthetics, reimbursement for the cost of the drugs or biologicals used in an arthrocentesis joint injection is allowed, in addition to the procedure.  Coverage is based on the terms of the member's benefit contract. The appropriate HCPCS code should be used for the drug administered.  If a separate charge for a local anesthetic is reported, it should be denied as not covered.  A participating, preferred, or network provider can bill the member for the denied service.

NOTE:

For guidelines on intra-articular injections of hyaluronan (Synvisc or Hyalgan) for osteoarthritis of the knee, see Medical Policy Bulletin G-25.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.