1 minute reading time (227 words)

AmeriHealth Applies New Frequency Limits to Trigger Point Injections

AmeriHealth of New Jersey has announced a policy change effective April 1, 2019 limiting the frequency of trigger point injections that will be covered. The revised policy limits the number of injections to a maximum number of ten sessions in a 12-month period.

Medicare does not have a national coverage policy for trigger point injections, however Medicare Administrative Contractors (MAC) may have local coverage policies in place. First Coast, Noridian and Novitas limit the frequency to no more than three sets (or sessions) of injections during one year. Palmetto and Wisconsin Physicians Service however have limits of four injections per year.In addition to the frequency limits, there are also varying clinical and documentation requirements imposed by the MACs.

Trigger point injections are reported with 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 muscles). As a reminder, the codes are reported based on the number of muscles treated and not the number of injections give. Therefore, only one code should be reported for each encounter and only 1 unit of service should be billed.

Practices should check the medical policies of its primary payers to determine limitations and other requirements for the coverage of these injections. View the AmeriHealth policy.

You can also view Medicare Local Coverage Determinations (LCDs) for trigger point injections.

Want more pain resources? Check out our library of on-demand education, upcoming events, and more.

Learn More