Issue: Payment for 20550/20551
I have received several inquires regarding Medicare (FCSO) policies (LCD) on injection codes
History: Recently, I argued a case with an ALJ (Administrative Law Judge) regarding apparent
confusion with the LCD that was referenced for injections. To avoid belaboring the issue, I
indicated that the policy under certain circumstances was inappropriately applied to adjudicate
claims for 20550 and 20551 resulting in denials to providers. After lengthy discussion and
substantiation of the argument, the judge agreed. I then took the argument to Medicare (FCSO)
and they agreed to honor my request and make appropriate changes.
My argument was that criteria for trigger point injections were erroneously being applied to
Resolution: Rather than writing a new policy on these codes, they were to modify the existing
LCD to avoid the confusion of applying trigger point injection criteria to these non-trigger point
Conclusion: This change is the result of my request to remove the restrictions from these codes.
This modified LCD should result in reimbursement of 20550/51 under appropriate
circumstances, eliminating denials that in the past resulted in non-payment for these services. By
removing these codes from the LCD, it eliminates the issues encountered (denials as stated). The
exclusion of these codes from the LCD is extremely favorable and in no way implies that these
codes are not billable. (An LCD is written when there are issues with provider utilization, i.e.,
abuse, over utilization etc. Therefore, one will note that many codes do not have an LCD. This
is a good thing. It is a bad thing when an LCD is written for a CPT code. That implies a
problem has been encountered and the payer is applying strict guidelines/parameters for
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Procedure code and description 95806 - Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory air...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...