Basics of CPT code 20561
In this exam, the physician inserts a dry solid filament needle through the skin and into one or two muscles in CPT code 20560 and into three or more muscles in CPT code 20561. Indicated for myofascial pain relief and movement impairments, trigger points (focal, discrete spots of hypersensitive irritability identified within bands of muscle) are often the target of insertion. These points cause local or referred pain and may be formed by acute or repetitive trauma to the muscle tissue. This procedure, also known as dry needling or trigger-point acupuncture, does not involve the administration of injectable therapeutic agents.
Points to remember for CPT code 20561
To assist users in reporting these services, parenthetical instructions were placed within this subsection and in other subsections in the code set directing users to the appropriate codes to report depending on the type of services performed. Parenthetical notes and guidelines were provided to prohibit reporting codes that may be mutually exclusive because the services overlap and/or because of alternative reporting instructions. These parentheticals include the following:
- An exclusionary parenthetical note following code 20553 prohibiting reporting of trigger-point injections (20552, 20553) in conjunction with needle insertions without injection (20560, 20561) for the same muscle(s);
- An instructional parenthetical note following code 97140 (manual therapy techniques) directing users to codes 20560 and 20561;
- Addition of a guideline in the Acupuncture subsection directing users to codes 20560 and 20561for needle insertion(s) without injection(s); and
- A parenthetical note following code 97814 (acupuncture) prohibiting reporting acupuncture services (ie, 97810, 97811, 97813, 97814) in conjunction with codes 20560 and 20561 and guidance to report only the time-based acupuncture codes when both time-based acupuncture services and needle insertion(s) without injection(s) are performed.
Medicare reimbursement for CPT code 20561, which refers to needle insertion(s) without injection(s) for 3 or more muscles, depends on factors like the specific Medicare Administrative Contractor (MAC) , the setting in which the service is provided, and the medical necessity (diagnosis) as documented in the patient’s medical records.
Modifiers eligible with CPT code 20561
For CPT code 20561 (Needle insertion(s) without injection(s); 3 or more muscles), the following modifiers may be applicable:
Modifier 50 – Bilateral Procedure
– Used when the procedure is performed on both sides of the body.
Modifier 51 – Multiple Procedures
– Applied when multiple procedures are performed during the same session.
Modifier 59 – Distinct Procedural Service
– Indicates that the procedure is distinct or independent from other services performed on the same day.
Modifier 76 – Repeat Procedure by Same Physician
– Used when the same procedure is repeated by the same physician on the same day.
Modifier 77 – Repeat Procedure by Another Physician
– Applied when the same procedure is repeated by a different physician on the same day.
Modifier 78 – Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
– Used when the patient returns to the operating room for a related procedure during the postoperative period.
Modifier 79 – Unrelated Procedure or Service by the Same Physician During the Postoperative Period
– Indicates that the procedure is unrelated to the original procedure and performed during the postoperative period.
Modifier LT – Left Side
– Used to specify that the procedure was performed on the left side of the body.
Modifier RT – Right Side
– Used to specify that the procedure was performed on the right side of the body.
Coding scenario for CPT code 20561
A 38-year-old female presents with neck pain, muscle-tension headaches, and diffuse right-shoulder myofascial pain.
The physician or other qualified health care professional palpates and locates the trigger points to be needled. Secure the first muscle between the fingers of the nonneedling hand. Insert sterile, single-use, solid-filament needles, varying from 32 to 38 gauge and 25 to 100 mm in length, at various depths and angles to achieve the desired result of releasing tight tissue, improving microcirculation, and removing neuronoxious chemicals.
Make interactive reassessments throughout the procedure, noting needle fibrillation, local twitch response, and/or reproduction of symptoms, including but not limited to achiness, burning, and electricity. Repeat this process for each additional muscle to be treated. Withdraw the needles and apply pressure (hemostasis) directly to the skin over the needle-insertion site.