Mountain State Medical Policy Bulletin

Section: Surgery
Number: S-31
Topic: Arthrocentesis or Needling of Bursa
Effective Date: July 21, 2008
Issued Date: July 21, 2008
Date Last Reviewed:

General Policy Guidelines

Indications and Limitations of Coverage

Payment should be made for needling of a bursa, including an adventitious bursa, under the appropriate arthrocentesis code. This includes injection of carpal tunnel, heel spur, ganglion cyst and Baker's cyst. Arthrocentesis or needling of bursa performed in connection with the fingers or toes, e.g., interphalangeal, metacarpal-phalangeal or metatarsal-phalangeal joints, should be reported under procedure code 20600.

Services performed in connection with the hand, foot, wrist (carpal tunnel) or ankle, e.g., carpal-metacarpal, tarsal-metatarsal, carpal or tarsal joints including the heel (heel spur) should be reported under procedure code 20605.

Claims reporting arthrocentesis or injection of the sacroiliac joint should be reported and paid under procedure code 20610.

Arthrocentesis reported for other areas of the spine, i.e., cervical, dorsal, lumbar, lumbosacral or coccyx should be processed as injection of trigger points (procedure codes 20552, and 20553).  However, when a doctor reports his services as arthrocentesis by fluoroscopy, the service should be processed under the appropriate procedure code for arthrocentesis of the type joint involved. Itemized charges should be combined and processed under the appropriate arthrocentesis code.  Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day.  When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines.

Except for local anesthetics, reimbursement for the cost of the drugs or biologicals used in an arthrocentesis joint injection is allowed, in addition to the procedure.  Coverage is based on the terms of the member's benefit contract. The appropriate HCPCS code should be used for the drug administered.  If a separate charge for a local anesthetic is reported, it should be denied as not covered.  A participating, preferred, or network provider can bill the member for the denied service.

For guidelines on intra-articular injections of hyaluronan (Synvisc or Hyalgan) for osteoarthritis of the knee, see Medical Policy Bulletin G-25.

Procedure Codes


Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines



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Table Attachment

Text Attachment

Procedure Code Attachments

Diagnosis Codes


This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.