Podiatric claim - Heel pain diagnosis

Palmetto GBA Medicare


Why can’t a podiatrist submit CPT code injections for a heel pain diagnosis and have the injections covered?

Palmetto GBA has established a Local Coverage Determination (LCD) for 'Trigger Point & Tendon Sheath Injections,' which lists the diagnoses covered for CPT codes 20550 and 20551. CPT code 20550 is an injection of a single tendon sheath such as the plantar fascia. The procedure is covered for the diagnosis of plantar fasciitis (ICD-9 code 728.71), which is a common cause of heel pain. CPT code 20551 is an injection of a single tendon origin/insertion and is covered for Achilles tendonitis (ICD-9 code 726.71), which is another cause for heel pain. In these situations the specific condition being treated should be coded and not the symptom of heel pain. Heel pain as a symptom is not covered. We encourage you to review this LCD in its entirety, with particular attention to the listing of ICD-9 codes that support medical necessity for the specific procedure codes listed within this LCD.