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CPT code 20550: Tendon sheath injection, single tendon sheath, ligament, or aponeurosis2026 Medicare rate & RVUs in Iowa

Medication injection into one tendon sheath, ligament, or aponeurosis is reported for conditions such as trigger finger, de Quervain tenosynovitis, or plantar fasciitis.

CMS RVU26DEffective Oct 1, 2026One payment locality795K Medicare services in 2024

In Iowa, Medicare pays $55.83 for 20550 in the office and $31.08 when it’s performed in a hospital or facility.

$55.83Office (non-facility)
$31.08Hospital or facility
−7.7%vs the national office rate ($60.46)

Check a contract rate as a % of Medicare · 20550 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 20550 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Iowa
  2. What 20550 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 20550 covers

This service delivers medication into a single tendon sheath, ligament, or aponeurosis, commonly a corticosteroid with local anesthetic. Typical targets include the flexor tendon sheath in trigger finger, the first dorsal wrist compartment in de Quervain tenosynovitis, and the plantar fascia in plantar fasciitis. Orthopedists, hand surgeons, podiatrists, rheumatologists, sports medicine clinicians, and primary care clinicians perform these injections in offices and facility settings.

Report one unit for injection(s) into one identified sheath, ligament, or aponeurosis; document each distinct target and side, technique, medication, and dose. Ultrasound needle guidance, when performed, requires separately documented guidance, retained images, and a report. Report practice-supplied medication with the appropriate HCPCS drug code and dose-based units. Medicare assigns a 0-day global period that includes routine same-day pre- and postoperative care; a separately identifiable E/M requires modifier 25. For multiple procedures in one session, the highest-valued is paid in full and others at 50%. Bilateral services with modifier 50 pay at 150%. Assistant-at-surgery services are not paid; co-surgeons and team surgery 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.

How Iowa compares for 20550

Across 109 of 109 payment localities, the office rate for 20550 runs from $54.34 in Arkansas to $76.36 in San Benito County, CA. Iowa pays $55.83. The RVUs are the same everywhere; the geographic indexes change the dollars.

20550 in Iowa vs other payment areas
  1. Iowa · this page$55.83
  2. Los Angeles, CA · California$66.50+$10.67
  3. Washington, DC area · District of Columbia$68.00+$12.17
  4. Miami, FL · Florida$66.41+$10.58
  5. Chicago, IL · Illinois$64.68+$8.85
  6. Manhattan, NY · New York$69.13+$13.30
  7. Alaska · Alaska$73.45+$17.62

Other areas in Iowa first, then benchmark localities. Bars start at $0.

Every other payment area

20550 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$55.02$31.34
ArkansasArkansas$54.34$31.10
ArizonaArizona$59.00$32.78
Bakersfield, CACalifornia$62.92$33.27
Chico, CACalifornia$62.65$33.00
El Centro, CACalifornia$62.66$33.01
Fresno, CACalifornia$62.65$33.00
Hanford, CACalifornia$62.65$33.00

20550 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$54.34

$73.45

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
20550 office rate range by state
State / territoryOffice rate rangeLocalities
AK$73.451
AL$55.021
AR$54.341
AZ$59.001
CA$62.65–$76.3629
CO$62.211
CT$64.121
DC$68.001
DE$59.881
FL$60.51–$66.413
GA$57.46–$61.662
GU$63.721
HI$63.721
IA$55.831
ID$56.231
IL$59.27–$64.684
IN$56.501
KS$55.791
KY$56.531
LA$56.53–$58.912
MA$61.99–$67.542
MD$60.85–$68.003
ME$56.67–$59.052
MI$57.97–$61.362
MN$59.301
MO$55.81–$58.873
MS$55.071
MT$60.451
NC$57.151
ND$58.671
NE$56.041
NH$61.441
NJ$64.76–$67.492
NM$58.321
NV$59.991
NY$57.91–$70.845
OH$57.601
OK$56.251
OR$59.43–$63.752
PA$57.58–$62.832
PR$60.771
RI$61.691
SC$57.491
SD$58.461
TN$56.051
TX$57.27–$62.088
UT$58.161
VA$59.01–$68.002
VI$60.771
VT$58.641
WA$61.81–$68.632
WI$56.991
WV$57.421
WY$59.671

See 20550 in every payment locality

How the 20550 rate is calculated

Each of 20550’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 · 20550

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.73

0.73 RVUs× 1.000 GPCI

Practice expense0.99

0.99 RVUs× 1.000 GPCI

Malpractice0.09

0.09 RVUs× 1.000 GPCI

Adjusted RVUs

1.8100

Conversion factor

$33.4009

Medicare rate

$60.46

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Iowa inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,759

Code
20550
Physician work
0.73
Practice expense
0.99
Malpractice
0.09

GPCI2026.csv

53

Locality
Iowa
Physician work
1.000
Practice expense
0.915
Malpractice
0.397
Office calculation for 20550 in Iowa
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0000.7300
Practice expense0.99× 0.9150.9059
Malpractice0.09× 0.3970.0357
Total RVUs1.6716
Conversion factor× 33.4009

Office rate, Iowa$55.83

Office: (0.73 × 1 + 0.99 × 0.915 + 0.09 × 0.397) × $33.4009 = $55.83

Facility: (0.73 × 1 + 0.18 × 0.915 + 0.09 × 0.397) × $33.4009 = $31.08

Open 20550 in the RVU calculator

Payment rules and modifiers for 20550

The CMS indicators that decide how 20550 is paid alongside other services.

CMS payment indicators · 20550

Tendon sheath injection, single tendon sheath, ligament, or aponeurosis

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

20550 without 50 · national office

$60.46

Tendon sheath injection, single tendon sheath, ligament, or aponeurosis

20550-50 · Bilateral: 150%

$90.69

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).

When to use modifier 50

Codes related to 20550

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 20550
CodeHow it relatesOffice range, Iowa
Used instead
20551Tendon injection, tendon origin or insertionUse instead when a therapeutic tendon injection targets its origin or insertion rather than its sheath.$56.01
Often billed with
76942Ultrasound needle guidance, biopsy, aspiration, injection, or localizationUltrasound needle guidance, separately reportable when performed with retained images and a report.$59.83
J3301Triamcinolone injection, per 10 mgTriamcinolone acetonide supply, measured in 10 mg units when supplied by the practice.No office rate
J1010Methylprednisolone acetate, per 1 mgMethylprednisolone acetate supply, measured in 1 mg units when supplied by the practice.No office rate

How 20550 has changed in Iowa

20550 · Office / nonfacility

$55.83

Effective 2026-10-01

The base rate is $3.51 higher than on 2025-10-01, moving from $52.32 to $55.83 (6.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $52.32changed to$55.83

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.75 changed to 0.73
    • Practice expense RVU 0.90 changed to 0.99
    • Malpractice RVU 0.10 changed to 0.09
    • Practice expense GPCI 0.913 changed to 0.915
    • Malpractice GPCI 0.457 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $53.54changed to$52.32

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 0.89 changed to 0.90

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $52.66changed to$53.54

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $54.05changed to$52.66

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.88 changed to 0.89
    • Practice expense GPCI 0.910 changed to 0.913
    • Malpractice GPCI 0.441 changed to 0.457

  5. January 1, 2023

    RVU23A

    $54.11changed to$54.05

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 0.85 changed to 0.88
    • Practice expense GPCI 0.907 changed to 0.910
    • Malpractice GPCI 0.425 changed to 0.441

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $52.82changed to$54.11

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 0.80 changed to 0.85
    • Malpractice RVU 0.09 changed to 0.10

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $52.01changed to$52.82

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.72 changed to 0.80
    • Malpractice GPCI 0.424 changed to 0.425

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $50.30changed to$52.01

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 0.67 changed to 0.72
    • Malpractice GPCI 0.423 changed to 0.424

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $50.25changed to$50.30

    • Conversion factor 35.9996 changed to 36.0391

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $49.76changed to$50.25

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 0.66 changed to 0.67
    • Practice expense GPCI 0.902 changed to 0.907
    • Malpractice GPCI 0.458 changed to 0.423

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $55.07changed to$49.76

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 0.83 changed to 0.66
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 0.493 changed to 0.458

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $55.59changed to$55.07

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 0.84 changed to 0.83

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $55.31changed to$55.59

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $54.43changed to$55.31

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 0.82 changed to 0.84
    • Malpractice RVU 0.08 changed to 0.09
    • Practice expense GPCI 0.892 changed to 0.896
    • Malpractice GPCI 0.475 changed to 0.493

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $53.62changed to$54.43

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.89 changed to 0.82
    • Practice expense GPCI 0.887 changed to 0.892
    • Malpractice GPCI 0.456 changed to 0.475

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $53.62

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$55.83$31.08RVU26D
2026-07-01$55.83$31.08RVU26C
2026-04-01$55.83$31.08RVU26B
2026-01-01$55.83$31.08RVU26A
2025-10-01$52.32$35.19RVU25D
2025-07-01$52.32$35.19RVU25C
2025-04-01$52.32$35.19RVU25B
2025-01-01$52.32$35.19RVU25A
2024-10-01$53.54$35.91RVU24D
2024-07-01$53.54$35.91RVU24C
2024-04-01$53.54$35.91RVU24B
2024-03-09$53.54$35.91RVU24AR
2024-01-01$52.66$35.32RVU24A
2023-10-01$54.05$36.47RVU23D
2023-07-01$54.05$36.47RVU23C
2023-04-01$54.05$36.47RVU23B
2023-01-01$54.05$36.47RVU23A
2022-10-01$54.11$36.84RVU22D
2022-07-01$54.11$36.84RVU22C
2022-04-01$54.11$36.84RVU22B
2022-01-01$54.11$36.84RVU22A
2021-10-01$52.82$37.00RVU21D
2021-07-01$52.82$37.00RVU21C
2021-04-01$52.82$37.00RVU21B
2021-01-01$52.82$37.00RVU21A
2020-10-01$52.01$37.94RVU20D
2020-07-01$52.01$37.94RVU20C
2020-04-01$52.01$37.94RVU20B
2020-01-01$52.01$37.94RVU20A
2019-10-01$50.30$37.88RVU19D
2019-07-01$50.30$37.88RVU19C
2019-04-01$50.30$37.88RVU19B
2019-01-01$50.30$37.88RVU19A
2018-10-01$50.25$37.84RVU18D
2018-07-01$50.25$37.84RVU18C
2018-04-01$50.25$37.84RVU18B
2018-01-01$50.25$37.84RVU18AR1
2017-10-01$49.76$37.78RVU17D
2017-07-01$49.76$37.78RVU17C
2017-04-01$49.76$37.78RVU17B
2017-01-01$49.76$37.78RVU17A
2016-10-01$55.07$39.99RVU16D
2016-07-01$55.07$39.99RVU16C
2016-04-01$55.07$39.99RVU16B
2016-01-01$55.07$39.99RVU16A
2015-10-01$55.59$40.14RVU15D
2015-07-01$55.59$40.14RVU15C
2015-04-01$55.31$39.94RVU15B
2015-01-01$55.31$39.94RVU15A
2014-10-01$54.43$39.73RVU14D
2014-07-01$54.43$39.73RVU14C
2014-04-01$54.43$39.73RVU14B
2014-01-01$54.43$39.73RVU14A
2013-10-01$53.62$38.23RVU13D
2013-07-01$53.62$38.23RVU13C
2013-04-01$53.62$38.23RVU13B
2013-01-01$53.62$38.23RVU13AR

Price 20550 for an earlier date of service

Where the Iowa rate applies

Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.

  • Ackley
  • Ackworth
  • Adair
  • Adel
  • Afton
  • Agency
  • Ainsworth
  • Akron

Browse all communities in Iowa

20550 billing questions

Should a lateral epicondylitis injection be coded here or with 20551?

Injection at a tendon origin or insertion, such as the common extensor origin at the lateral epicondyle, is reported with 20551. Use 20550 when the target is a tendon sheath, ligament, or aponeurosis such as the plantar fascia.

How are injections of two different trigger fingers on the same hand reported?

Report each distinct tendon sheath separately and identify the injected digits. Append a distinct-site modifier when required to distinguish the services; Medicare's same-session multiple procedure reduction applies.

Can ultrasound guidance be billed with 20550?

Yes. Ultrasound needle guidance may be reported with 76942 when performed, with retained images and a separate guidance report.

Is the corticosteroid separately billable?

When the practice supplies it, report an eligible drug with its HCPCS code and documented dose-based units. For J3301, one unit represents 10 mg of triamcinolone acetonide, so 40 mg is four units.

Can an office visit be billed on the same day?

A significant, separately identifiable E/M service beyond the usual pre-injection assessment may be reported with modifier 25. The routine decision to inject is included in the 0-day global care.

When is modifier 50 appropriate?

For corresponding structures injected on both sides in one session, such as bilateral plantar fascia injections, report 20550 with modifier 50 on one line with one unit. Medicare pays the bilateral service at 150%.

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
RVUs for 20550PPRRVU2026_Oct_nonQPP.csv, line 1,759 (RVU26D)
Geographic factors for IowaGPCI2026.csv, line 53 (RVU26D)

Open CMS sourceHow we calculate rates

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