Hello all. If you are having trouble getting 20610 or 20611 paid for subsequent injections this is going to help. I am in KY CGS is my MAC. i just learned that you have to apply -EJ to the drug code for subsequent visits or both the injection and drug code will deny. thought I would post this in the event others were having trouble.
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Wiki NEW CGS ARTICLE FOR 20610 20611 REVISED 05/01/2021
- Thread starter jrclark1987@yahoo.com
- Start date
Katherin1994
Guest
Hi is there a global of one injection every 6 months or is it consecutively with meeting the requirements that each "course" needs to be spaced out? We have billed within a few weeks of each other and I am curious if you know if it's each injection or if we are treating the knee then when we do injections for another part of the body is considered a separate "course".
Thank you for all of your help and for posting this. Helps me big time!
Katherin
SharonCollachi
Guest
Utilization:
The dose and frequency of administration should be consistent with the FDA approved labeling.
It is expected that an injection (Synvisc-One ™, Gel-One®, Durolane®) or course of the injections (Synvisc®, Hyalgan®, Supartz® or Visco-3™, Euflexxa™, Orthovisc®, GelSyn-3™, GenVisc® 850, Hymovis®, TriVisc™, Synojoynt™, Triluron™) will not be repeated within six months time.
A repeat series of injections may be allowed when:
Coding information:
The dose and frequency of administration should be consistent with the FDA approved labeling.
It is expected that an injection (Synvisc-One ™, Gel-One®, Durolane®) or course of the injections (Synvisc®, Hyalgan®, Supartz® or Visco-3™, Euflexxa™, Orthovisc®, GelSyn-3™, GenVisc® 850, Hymovis®, TriVisc™, Synojoynt™, Triluron™) will not be repeated within six months time.
A repeat series of injections may be allowed when:
- The indications continue to be met; and
- Significant improvement in pain and functional capacity from the prior series of injections is documented in the medical record; and
- The last injection (in a prior course) was given at least six (6) months ago.
Coding information:
- If an aspiration and an injection procedure are performed at the same session, bill only one unit for CPT code 20610 or 20611.
- The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or 20611 to indicate if the service was performed unilaterally and modifier (50) must be appended to indicate if the service was performed bilaterally.
- Use "EJ" modifier on drug codes to indicate subsequent injections of a series. Do not use this modifier for the first injection of each series. A series is defined as the set of injections for each joint and each treatment. Injection of the left knee or shoulder is a separate series from injection of the right knee or shoulder.
- If the drug is denied as not reasonable and necessary, the associated injection code will also be denied.