CPT code 20527: Palmar cord injection, enzyme injection2026 Medicare rate & RVUs in Missouri
Report this service for injecting collagenase into a palmar fascial cord to treat Dupuytren contracture, typically as part of a staged treatment plan.
Medicare pays $86.42–$91.56 for 20527 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 20527 covers
A clinician injects collagenase into a palpable cord of thickened palmar fascia causing Dupuytren contracture. Hand surgeons and other clinicians who treat hand disorders commonly perform the injection in an office or outpatient setting. The enzyme weakens the targeted cord; a separate manipulation may be performed at a later visit to help extend the affected finger. Document the cord and hand treated, the contracture findings, and the injection performed.
Report 20527 for the injection service, not for the later manipulation. When collagenase is supplied and separately reportable, the drug is reported with its applicable drug code and units. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted, and co-surgery and team-surgery payment are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 20527 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$86.42 to $91.56
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $90.68 | $57.12 |
| Metropolitan St. Louis, MO | $91.56 | $57.53 |
| Rest of Missouri | $86.42 | $55.61 |
How the 20527 rate is calculated
Each of 20527’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 20527
RVUs × geographic indexes × conversion factor
Work0.98
0.98 RVUs× 1.000 GPCI
Practice expense1.65
1.65 RVUs× 1.000 GPCI
Malpractice0.19
0.19 RVUs× 1.000 GPCI
Adjusted RVUs
2.8200
Conversion factor
$33.4009
Medicare rate
$94.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 20527
The CMS indicators that decide how 20527 is paid alongside other services.
CMS payment indicators · 20527
Palmar cord injection, enzyme injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
20527 without 50 · national office
$94.19
Palmar cord injection, enzyme injection
20527-50 · Bilateral: 150%
$141.29
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
20527 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 26341Cord manipulationAfter enzyme injection
- This code describes manipulation of a palmar fascial cord after injection, not the collagenase injection itself. It is commonly performed at a later visit.
- 26040Palm contracture releasePercutaneous technique
- Use 26040 for percutaneous division of palmar fascia; use 20527 when collagenase is injected into the cord.
- 26121Palmar fasciectomyPalm only
- Use 26121 for surgical removal of palmar fascia. Code 20527 describes enzyme injection and does not represent excision.
20527 billing questions
When should 20527 be chosen instead of a palmar fasciectomy code?
Use 20527 for enzyme injection into a palmar fascial cord. A fasciectomy code describes surgical removal of diseased fascia, not injection treatment.
Is the post-injection finger manipulation included in 20527?
No. The manipulation is a separate service, commonly reported with 26341 when performed after collagenase injection; it is typically done at a later visit.
Can the collagenase drug be reported separately?
When the drug is separately reportable, report it with the applicable drug code, such as J0775, using units based on the amount administered. The 20527 service represents the injection procedure.
What documentation supports reporting 20527?
Document the Dupuytren contracture, the targeted palmar fascial cord and hand, and the collagenase injection performed. Record the drug and amount administered when needed to support separate drug reporting.
How is 20527 reported when both hands are treated?
CMS lists bilateral reporting with modifier 50, paid at 150%. Document the injection on each side.
Does 20527 have a postoperative global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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