Tuesday, July 27, 2010

20550: Injection of tendon sheath, ligament or trigger points -- LCD revision

20550: Injection of tendon sheath, ligament or trigger points -- LCD revision

LCD ID number: L29199 (Florida)
LCD ID number: L29351 (Puerto Rico/U.S. Virgin Islands)

The local coverage determination (LCD) for injection of tendon sheath, ligament or trigger points was effective for services rendered on or after February 2, 2009, for Florida, and on or after March 2, 2009, for Puerto Rico and the U.S. Virgin Islands as a Medicare administrative contractor (MAC) LCD for jurisdiction 9 (J9). Since that time, the LCD has been revised to remove CPT codes 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia) and 20551 (Injection(s); single tendon origin/insertion). The language pertaining to these CPT codes was removed from the Indications and Limitations of Coverage and/or Medical Necessity, ICD-9 Codes that Support Medical Necessity, and Documentation Requirements sections of the LCD.

The remaining CPT codes 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle[s]) and 20553 (Injection(s); single or multiple trigger point(s), 3 or more muscle[s]) in the LCD address trigger point injections, therefore, the LCD number and title were changed to 20552 - Injection of Trigger Points.

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download