HEALTHFIRSTHealthfirst Reimbursement Policy Updates Frequency of Trigger Point Injections
As a reminder, Healthfirst does not reimburse more than three (3) trigger point injections in a 90-day period. For All Lines of Business!
According to CMS policy (LCD L35010 Jurisdiction H-L), “It is expected that trigger point injections would not usually be performed more often than three sessions in a three-month period. If trigger point injections are performed more than three sessions in a three-month period, the reason for repeated performance and the substances injected should be evident in the medical record and available to the Contractor upon request.”
This policy applies to the following CPT codes:
20552: Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
20553: Injection(s); single or multiple trigger point(s), 3 or more muscles
Source: https://hfproviders.org/documents/root/0759-21_Reimbursement Policy_Updates_TriggerPointInjections_FINAL.pdf