Bone Marrow Aspirate

Question:

Good afternoon,
One of our physicians is performing an injection of bone marrow aspirate concentrate into infraspinatus, supraspinatus tendons and the glenohumeral joint, under ultrasound guidance. Bone marrow was aspirated from bilateral iliac crests under US guidance and processed via centrifugation. How should this be reported?
Thank you

Answer:

CPT Category III code 0232T was introduced in 2010 for reporting injection of platelet rich plasma to a targeted site; the code definition includes all harvesting, preparation, and image guidance for the service. In August 2010 the AAOS published guidance in AAOS Now which explained “The new code is to be used only when PRP is performed in a complete separate patient encounter from a surgical procedure.”

Based on this direction, when PRP is injected during another procedure, whether using drawn blood or bone marrow aspirate, it is not separately reportable with the primary surgical service.

If PRP injection is the only service performed, then 0232T is the correct code. In recent years some physicians have begun using bone marrow aspirate harvested from the iliac crest instead of drawn blood for PRP preparation, and reporting the harvesting using CPT code 38220. The May 2012 edition of CPT Assistant clarified that 0232T is the only code reportable for PRP injection, whether performed using drawn blood or harvested bone marrow aspirate. In 2018 the definition of 38220 was changed to reflect that it should be used only for diagnostic bone marrow aspiration. New code 20939 should be used when bone marrow aspiration is performed for bone grafting, for spine surgery only, via a separate incision. CPT instructs to use 20999 for bone grafting, other than spine surgery and other therapeutic musculoskeletal applications.

*This response is based on the best information available as of 12/04/25.

Injections and E/M Visits

Question:

How do you code for an unplanned injection as well as the E&M service necessary to make the decision to perform the injection?

Answer:

The answer to this question depends upon if you are providing a significant and separate evaluation and management service in addition to an injection, and not whether the injection was planned or unplanned.  Every minor procedure has time for pre-service evaluation included in the value of the procedure code. Medicare and other payors have become concerned that E/M’s are being routinely reported with minor procedures without considering if the extent of the visit was truly more than the pre-service evaluation already included in the procedure. Just because an injection is unplanned does not automatically allow for an E/M visit to be billed. There must be a significant and separately identifiable E/M service above and beyond the injection. Please listen to our KZA KAST Modifier Monday podcast on Modifier 25 for additional information.

https://monday.transistor.fm/

*This response is based on the best information available as of 11/20/25.

Therapeutic Epidural Injection

Question:

I’ve just taken on coding for pain management and could use some assistance. A patient came to our pain management clinic with chronic lower back pain. The physician performs a therapeutic epidural steroid injection at the L4-L5 interspace using fluoroscopic guidance. The physician personally performs and documents the fluoroscopic guidance. What is the correct CPT code(s) for this procedure?

Answer:

Congratulations for your new role and thank you for reaching out to us. The recommended CPT code is 62323 - Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT).

*This response is based on the best information available as of 11/06/25.

LCD Clarification

Question:

Does the LCD L33622 Pain Management - Injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels apply to trigger finger injections? I am reading the LCD and the title but not seeing where it applies specifically to trigger finger questions. 

Answer:

Yes, the LCD does apply to trigger finger injections. You are correct, that in the actual LCD there is not a specific reference to this diagnosis, including the title.  

Look at the links in the Associated Diagnosis section of the LCD. You will find the following link which takes you to the coding and billing requirements. CPT code 20550 and the diagnosis codes for trigger finger are listed in this document. 

 A52863 - Billing and Coding: Pain Management - injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels. 

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52863&ver=51 

*This response is based on the best information available as of 10/23/25.

Modifier 59 vs Modifier 51

Question:

Can you clarify when to use modifiers 59 vs 51?

Answer:

Modifier 59 (or X modifiers) should only be used for a bundling edit to unbundle two codes that are not usually reported together but are appropriate under specific circumstances. If there is no bundling edit between two codes, then modifier 51 is appended to the second code to indicate an additional procedure.

*This response is based on the best information available as of 10/09/25.

Reporting Modifiers with Unlisted Codes

Question:

Can modifiers be reported with unlisted CPT codes?

Answer:

Yes, modifiers can be appended to unlisted CPT codes.

In 2024, CPT clarified this by updating the introduction guidelines for unlisted procedures and services. These updates were further explained in the January 2024 issue of CPT Assistant, which addressed the new and revised text and the standardization of reporting unlisted CPT codes across the CPT code set.

Illustration of modifiers that may be appropriately applied includes:

• Laterality modifiers – e.g., RT (right), LT (left)

• Bilateral procedure modifier – 50

• Role-based modifiers – e.g., 62 (two surgeons), 80 (assistant surgeon), 82 (assistant surgeon when qualified resident not available), AS (non-physician surgical assistant)

• Multiple or distinct procedure modifiers – e.g., 51 (multiple procedures), 59 (distinct procedural service)

• Global modifiers – e.g., 58 (staged or related procedure), 78 (return to operating room for related procedure), 79 (unrelated procedure or service)

This is not an all-inclusive list of modifiers that may be appropriately applied to unlisted CPT codes. For complete and up-to-date information, one should refer to current CPT guidelines and payer-specific policies.

Please note: Modifiers that describe an alteration of a service or procedure, such as modifier 52 (reduced services), are not appropriate for use with unlisted codes. The same applied to modifier 22 (increased procedural services).

*This response is based on the best information available as of 9/22/25.