The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Hyaluronic Acid Injections for Knee Osteoarthritis L39260.
*Note: The prescribing information for the dose and frequency of administration should be consistent with the United States (U.S.) Food and Drug Administration (FDA) approved labeling.
Billing subsequent injections in a series (EJ modifier):
Use EJ modifier with the HCPCS code for the drug administered to indicate subsequent injections of a series. Do not use this modifier for the first injection of each series. A series is defined as a set of injections for each joint and each treatment.
JW Modifier Requirement:
Effective January 1, 2017, the Centers for Medicare and Medicaid Services (CMS) issued CR 9603, regarding the use of the JW modifier for discarded Part B drugs and biologicals. Providers are required to use the JW modifier for claims with unused drugs or biologicals from single use vials or single use packages that are appropriately discarded (except those provided under the CAP for Part B drugs and biologicals). Document the discarded drug or biological in the patient’s medical record when submitting claims with unused Part B drugs or biologicals from single use vials or single use packages that are appropriately discarded.
Billing the injection procedure:
- The CPT® code (procedure code) 20610 or 20611 (with ultrasound guidance) may be billed for the intra-articular injection in addition to the drug.
- If an aspiration and an injection procedure are performed at the same session, bill only 1 unit for CPT® code 20610 or 20611.
- When additional substances simultaneously administer (e.g., cortisone, anesthetics) with viscosupplementation, only 1 injection service is allowed per knee.
- The appropriate site modifier (RT or LT) must be appended to CPT® code 20610 or CPT® code 20611 to indicate if the service was performed unilaterally and modifier (50) must be appended to indicate if the service was performed bilaterally.
- An Evaluation and Management (E&M) service may be appropriate if the decision to start the series of injections is made after an evaluation during the same visit. Indicate this by using an E&M code with modifier -25.
- An E&M service should not be reported for subsequent injections unless there was a separately identifiable problem for which the E&M service was required and rendered.