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CPT 20552


Hello:  We're billing 99213 and 20552 to Medicaid and they paid the 99213 but is asking for a modifier for 20552.  Does anyone what modifier that would be?
Thank you in advance for your help.

The only modifiers I can think of that they would be wanting is the LT/RT modifiers(which are not modifiers usually needed for this code), but the problem is depending on where the trigger point injections were given, this will not always work. If they are in someone's back, for instance. Or neck. Have you actually called Medicaid to ask them what it is they are looking for? They generally won't tell you exactly which modifier it is, but they should be able to give you a better idea.

It could be due to the ICD codes used on both Office visit and the TPI code. What primary and additional ICD codes were used on these codes? Hope there was a 25 mod used for the office visit?


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