Anthem Blue Cross and Blue Shield

Central Region Clinical Claim Edit

Subject: Injection(s) Single Tendon Sheath or Ligament or Trigger Points into Muscles with
Arthrocentesis, Aspiration and/or Injection; Small joint or Bursa to Major Joint
Edit# 646 Effective: 01/16/2009 – 12/31/2014

Coverage is subject to the terms, conditions, and limitations of an individual member’s programs or
products and the edit criteria listed below. Please compare the claim's date of adjudication to the range
of the edit in question. Prior versions, if any, can be found below.

Description

CODE RULE CODE

20550 Incidental 20600

20551 20605
20552 20610
20553
20550-59 Separate Reimbursement 20600
20551-59 20605
2055259 20610
20553-59

Rationale

Anthem Central Region bundles 20550, 20551, 20552 and 20553 as incidental to 20600, 20600-50,
20600-LT, 20600-RT, 20600-FA-F9, 20600-TA-T9, 20605, 20605-50, 20605-LT, 20605-RT, 20610,
20610-50, 20610-LT and 20610-RT. Based on the National Correct Coding Initiative Edits, cods 20550,
20551, 20552 and 20553 are listed as component codes to codes 20600, 20605 and 20610. Therefore, if
20550, 20551, 20552 or 20553 is submitted with 20600, 20600-50, 20600-LT, 20600-RT, 20600-FA-
F9, 20600-TA-T9, 20605, 20605-50, 20605-LT, 20605-RT, 20610, 20610-50, 20610-LT and 20610-
RT— only 20600, 20600-50, 20600-LT, 20600-RT, 20600-FA-F9, 20600-TA-T9, 20605, 20605-50,
20605-LT, 20605-RT, 20610, 20610-50, 20610-LT and 20610-RT reimburses.

Anthem Central Region does not bundle 20550-59, 20551-59, 20552-59 and 20553-59 with 20600,
20600-LT, 20600-RT, 20600-FA-F9, 20600-TA-T9, 20605, 20605-LT, 20605-RT, 20610, 20610-LT
and 20610-RT. If 20550, 20551, 20552 or 20553 is performed on one anatomical site and 20600,
20600-LT, 20600-RT, 20600-FA-F9, 20600-TA-T9, 20605, 20605-LT, 20605-RT, 20610, 20610-LT
and 20610-RT is performed on a separate/different anatomical site, append modifier 59 to 20550,
20551, 20552 or 20553 and both services reimburse separately.

References

1. Centers for Medicare and Medicaid (October 1, 2008-December 31, 2008) National Correct
Central Region Claim Edit#646 Page 1 of 2
Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc. independent licensee of the Blue Cross and Blue Shield Association
® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. CPT © is a registered trademark of the American Medical Association
Use of Central Claim Edits: This Edit is subject to federal and state laws, to the extent applicable, as well as the terms, conditions, and limitations of a member’s benefits on the
date of service. Claim Edits are constantly evolving and we reserve the right to review and update these edits periodically.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise,
without permission from Anthem Blue Cross Blue Shield.
 Anthem Blue Cross and Blue Shield
Central Region Clinical Claim Edit

Coding Initiative Edits-Version 14.3. Retrieved October 7, 2008 from the World Wide Web:
http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/itemdetail.asp?filterType=none&filt
erByDID=-99&sortByDID=2&sortOrder=ascending&itemID=CMS046397&intNumPerPage=10

Claim Edit History

01/01/2015 Archived
01/16/2009 Revised
02/29/2008 Adopted

Central Region Claim Edit#646 Page 2 of 2

Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc. independent licensee of the Blue Cross and Blue Shield Association
® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. CPT © is a registered trademark of the American Medical Association
Use of Central Claim Edits: This Edit is subject to federal and state laws, to the extent applicable, as well as the terms, conditions, and limitations of a member’s benefits on the
date of service. Claim Edits are constantly evolving and we reserve the right to review and update these edits periodically.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise,
without permission from Anthem Blue Cross Blue Shield.