HEALTHFIRSTHealthfirst Reimbursement Policy Updates
Effective September 1, 2021, several changes will be made to reimbursement policy to maintain compliance with industry-accepted coding and reimbursement practices as well as state and national regulatory requirements.
Arthrocentesis, Aspiration, or Injection of a Major Joint Policy Overview
Effective September 1, 2021, Healthfirst will no longer reimburse an arthrocentesis, aspiration, or injection of a major joint without an appropriate indication.
According to the CPT manual, these codes describe procedures done on a “major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa)”. Submitting a diagnosis code that does not indicate a “major joint or bursa” will result in a denied line. Procedures done on smaller joints should be coded using the appropriate CPT and ICD-10-CM code for the procedure’s anatomical location.
This policy applies to the following CPT codes:
20610: Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance.
20611: Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting.