CPT code 20553: Trigger point injection, three or more muscles2026 Medicare rate & RVUs in Washington, DC area
Reports medication injection into trigger points in three or more muscles to treat myofascial pain during a single session.
In Washington, DC area, Medicare pays $67.23 for 20553 in the office and $44.81 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 20553 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 20553 covers
This service treats myofascial pain by placing a needle into trigger points in three or more muscles and injecting medication at the identified sites. A trigger point is a tender, taut area within muscle associated with the patient’s symptoms; the target is muscle rather than a tendon sheath or tendon attachment. Physicians and other qualified practitioners commonly perform these injections in office-based pain, rehabilitation, primary care, or orthopedic settings.
Select the code by the number of muscles treated, not the number of trigger points or needle passes: 20553 covers three or more muscles, while 20552 covers one or two. Document the muscles and sites treated, relevant examination findings, and the procedure performed. 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 others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; 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 Washington, DC area compares for 20553
Across 109 of 109 payment localities, the office rate for 20553 runs from $53.88 in Arkansas to $75.70 in San Benito County, CA. Washington, DC area pays $67.23. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Washington, DC area · this page$67.23
- Los Angeles, CA · California$65.88−$1.35
- Miami, FL · Florida$65.22−$2.01
- Chicago, IL · Illinois$63.58−$3.65
- Manhattan, NY · New York$68.22+$0.99
- Alaska · Alaska$72.91+$5.68
- Alabama · Alabama$54.54−$12.69
Other areas in District of Columbia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $53.88 | $37.52 |
| ArizonaArizona | $58.39 | $39.94 |
| Bakersfield, CACalifornia | $62.35 | $41.48 |
| Chico, CACalifornia | $62.10 | $41.24 |
| El Centro, CACalifornia | $62.12 | $41.25 |
| Fresno, CACalifornia | $62.10 | $41.24 |
| Hanford, CACalifornia | $62.10 | $41.24 |
| Madera, CACalifornia | $62.10 | $41.24 |
| Merced, CACalifornia | $62.10 | $41.24 |
| Modesto, CACalifornia | $62.10 | $41.24 |
| Napa, CACalifornia | $70.42 | $45.33 |
| Oxnard, CACalifornia | $65.42 | $42.92 |
| Redding, CACalifornia | $62.10 | $41.24 |
| Rest of CaliforniaCalifornia | $62.10 | $41.24 |
| Riverside, CACalifornia | $62.98 | $42.11 |
| Sacramento, CACalifornia | $64.76 | $42.62 |
| Salinas, CACalifornia | $64.51 | $42.44 |
| San Diego, CACalifornia | $65.71 | $42.94 |
| Marin County, CACalifornia | $74.08 | $47.23 |
| San Francisco, CACalifornia | $73.99 | $47.14 |
| San Benito County, CACalifornia | $75.70 | $48.24 |
| Santa Clara County, CACalifornia | $75.33 | $47.87 |
| San Luis Obispo, CACalifornia | $63.51 | $41.83 |
| Santa Cruz, CACalifornia | $66.10 | $42.97 |
| Santa Maria, CACalifornia | $64.66 | $42.47 |
| Santa Rosa, CACalifornia | $66.74 | $43.36 |
| Stockton, CACalifornia | $62.10 | $41.24 |
| Vallejo, CACalifornia | $70.29 | $45.19 |
| Visalia, CACalifornia | $62.10 | $41.24 |
| Yuba City, CACalifornia | $62.10 | $41.24 |
| ColoradoColorado | $61.59 | $41.33 |
| ConnecticutConnecticut | $63.36 | $42.85 |
| DelawareDelaware | $59.25 | $40.44 |
| Fort Lauderdale, FLFlorida | $62.37 | $43.09 |
| Rest of FloridaFlorida | $59.69 | $41.49 |
| Atlanta, GAGeorgia | $60.92 | $41.58 |
| Rest of GeorgiaGeorgia | $56.77 | $39.78 |
| Hawaii, Guam, HIHawaii | $63.15 | $41.50 |
| IowaIowa | $55.39 | $37.97 |
| IdahoIdaho | $55.76 | $38.25 |
| East St. Louis, ILIllinois | $59.88 | $42.36 |
| Rest of IllinoisIllinois | $58.44 | $41.06 |
| Suburban Chicago, ILIllinois | $62.90 | $43.35 |
| IndianaIndiana | $56.02 | $38.38 |
| KansasKansas | $55.32 | $38.11 |
| KentuckyKentucky | $55.93 | $39.00 |
| New Orleans, LALouisiana | $58.22 | $40.30 |
| Rest of LouisianaLouisiana | $55.91 | $39.06 |
| Metropolitan Boston, MAMassachusetts | $66.84 | $44.11 |
| Rest of MassachusettsMassachusetts | $61.37 | $41.32 |
| Baltimore area, MDMaryland | $63.20 | $42.77 |
| Rest of MarylandMaryland | $60.21 | $40.94 |
| Rest of MaineMaine | $56.16 | $38.64 |
| Southern Maine, MEMaine | $58.51 | $39.64 |
| Detroit, MIMichigan | $60.48 | $42.10 |
| Rest of MichiganMichigan | $57.28 | $39.90 |
| MinnesotaMinnesota | $58.86 | $39.27 |
| Metropolitan Kansas City, MOMissouri | $57.73 | $39.85 |
| Metropolitan St. Louis, MOMissouri | $58.22 | $40.10 |
| Rest of MissouriMissouri | $55.20 | $38.79 |
| MississippiMississippi | $54.54 | $38.15 |
| MontanaMontana | $59.78 | $40.74 |
| North CarolinaNorth Carolina | $56.63 | $38.87 |
| North DakotaNorth Dakota | $58.20 | $39.16 |
| NebraskaNebraska | $55.61 | $38.03 |
| New HampshireNew Hampshire | $60.80 | $40.98 |
| Northern New JerseyNew Jersey | $66.74 | $44.66 |
| Rest of New JerseyNew Jersey | $64.03 | $43.24 |
| New MexicoNew Mexico | $57.61 | $40.15 |
| NevadaNevada | $59.37 | $40.32 |
| NYC suburbs and Long Island, NYNew York | $69.82 | $47.19 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $64.56 | $43.71 |
| Queens, NYNew York | $68.49 | $45.98 |
| Rest of New YorkNew York | $57.36 | $39.27 |
| OhioOhio | $56.96 | $39.58 |
| OklahomaOklahoma | $55.69 | $38.69 |
| Portland, OROregon | $63.13 | $41.98 |
| Rest of OregonOregon | $58.86 | $39.90 |
| Metropolitan Philadelphia, PAPennsylvania | $62.08 | $42.27 |
| Rest of PennsylvaniaPennsylvania | $56.96 | $39.48 |
| Puerto RicoPuerto Rico | $60.11 | $40.86 |
| Rhode IslandRhode Island | $61.04 | $41.38 |
| South CarolinaSouth Carolina | $56.90 | $39.31 |
| South DakotaSouth Dakota | $58.01 | $38.97 |
| TennesseeTennessee | $55.57 | $38.27 |
| Austin, TXTexas | $61.43 | $41.29 |
| Beaumont, TXTexas | $56.65 | $39.33 |
| Brazoria, TXTexas | $59.10 | $40.23 |
| Dallas, TXTexas | $59.50 | $40.53 |
| Fort Worth, TXTexas | $59.20 | $40.43 |
| Galveston, TXTexas | $59.29 | $40.39 |
| Houston, TXTexas | $60.76 | $41.85 |
| Rest of TexasTexas | $57.86 | $39.79 |
| UtahUtah | $57.55 | $39.65 |
| VirginiaVirginia | $58.45 | $39.73 |
| Virgin Islands, VIUnited States Virgin Islands | $60.11 | $40.86 |
| VermontVermont | $58.14 | $39.29 |
| Rest of WashingtonWashington | $61.20 | $41.15 |
| King County, WAWashington | $67.95 | $44.59 |
| WisconsinWisconsin | $56.56 | $38.32 |
| West VirginiaWest Virginia | $56.65 | $40.11 |
| WyomingWyoming | $59.09 | $40.05 |
20553 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$53.88
$72.91
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $72.91 | 1 |
| AL | $54.54 | 1 |
| AR | $53.88 | 1 |
| AZ | $58.39 | 1 |
| CA | $62.10–$75.70 | 29 |
| CO | $61.59 | 1 |
| CT | $63.36 | 1 |
| DC | $67.23 | 1 |
| DE | $59.25 | 1 |
| FL | $59.69–$65.22 | 3 |
| GA | $56.77–$60.92 | 2 |
| GU | $63.15 | 1 |
| HI | $63.15 | 1 |
| IA | $55.39 | 1 |
| ID | $55.76 | 1 |
| IL | $58.44–$63.58 | 4 |
| IN | $56.02 | 1 |
| KS | $55.32 | 1 |
| KY | $55.93 | 1 |
| LA | $55.91–$58.22 | 2 |
| MA | $61.37–$66.84 | 2 |
| MD | $60.21–$67.23 | 3 |
| ME | $56.16–$58.51 | 2 |
| MI | $57.28–$60.48 | 2 |
| MN | $58.86 | 1 |
| MO | $55.20–$58.22 | 3 |
| MS | $54.54 | 1 |
| MT | $59.78 | 1 |
| NC | $56.63 | 1 |
| ND | $58.20 | 1 |
| NE | $55.61 | 1 |
| NH | $60.80 | 1 |
| NJ | $64.03–$66.74 | 2 |
| NM | $57.61 | 1 |
| NV | $59.37 | 1 |
| NY | $57.36–$69.82 | 5 |
| OH | $56.96 | 1 |
| OK | $55.69 | 1 |
| OR | $58.86–$63.13 | 2 |
| PA | $56.96–$62.08 | 2 |
| PR | $60.11 | 1 |
| RI | $61.04 | 1 |
| SC | $56.90 | 1 |
| SD | $58.01 | 1 |
| TN | $55.57 | 1 |
| TX | $56.65–$61.43 | 8 |
| UT | $57.55 | 1 |
| VA | $58.45–$67.23 | 2 |
| VI | $60.11 | 1 |
| VT | $58.14 | 1 |
| WA | $61.20–$67.95 | 2 |
| WI | $56.56 | 1 |
| WV | $56.65 | 1 |
| WY | $59.09 | 1 |
How the 20553 rate is calculated
Each of 20553’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 · 20553
RVUs × geographic indexes × conversion factor
Work0.73
0.73 RVUs× 1.000 GPCI
Practice expense0.98
0.98 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
1.7900
Conversion factor
$33.4009
Medicare rate
$59.79
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Washington, DC area inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,762
- Code
- 20553
- Physician work
- 0.73
- Practice expense
- 0.98
- Malpractice
- 0.08
GPCI2026.csv
39
- Locality
- Washington, DC area
- Physician work
- 1.054
- Practice expense
- 1.178
- Malpractice
- 1.113
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.73 | × 1.054 | 0.7694 |
| Practice expense | 0.98 | × 1.178 | 1.1544 |
| Malpractice | 0.08 | × 1.113 | 0.0890 |
| Total RVUs | 2.0129 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Washington, DC area$67.23
Office: (0.73 × 1.054 + 0.98 × 1.178 + 0.08 × 1.113) × $33.4009 = $67.23
Facility: (0.73 × 1.054 + 0.41 × 1.178 + 0.08 × 1.113) × $33.4009 = $44.81
Payment rules and modifiers for 20553
The CMS indicators that decide how 20553 is paid alongside other services.
CMS payment indicators · 20553
Trigger point injection, three or more muscles
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 51 · payment effect
With and without the modifier
20553 without 51 · national office
$59.79
Trigger point injection, three or more muscles
20553-51 · Second procedure: 50%
$29.90
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 20553 has changed in Washington, DC area
20553 · Office / nonfacility
$67.23
Effective 2026-10-01
The base rate is $0.78 higher than on 2025-10-01, moving from $66.45 to $67.23 (1.2%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$66.45changed to$67.23
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.75 changed to 0.73
- Work GPCI 1.057 changed to 1.054
- Practice expense GPCI 1.192 changed to 1.178
- Malpractice GPCI 1.168 changed to 1.113
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$68.77changed to$66.45
- Conversion factor 33.2875 changed to 32.3465
- Malpractice RVU 0.09 changed to 0.08
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$67.65changed to$68.77
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$71.33changed to$67.65
- Conversion factor 33.8872 changed to 32.7442
- Malpractice RVU 0.10 changed to 0.09
- Work GPCI 1.056 changed to 1.057
- Practice expense GPCI 1.214 changed to 1.192
- Malpractice GPCI 1.231 changed to 1.168
January 1, 2023
RVU23A
$73.75changed to$71.33
- Conversion factor 34.6062 changed to 33.8872
- Work GPCI 1.054 changed to 1.056
- Practice expense GPCI 1.236 changed to 1.214
- Malpractice GPCI 1.294 changed to 1.231
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$73.91changed to$73.75
- Conversion factor 34.8931 changed to 34.6062
- Malpractice RVU 0.09 changed to 0.10
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$75.73changed to$73.91
- Conversion factor 36.0896 changed to 34.8931
- Work GPCI 1.049 changed to 1.054
- Practice expense GPCI 1.221 changed to 1.236
- Malpractice GPCI 1.277 changed to 1.294
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$74.44changed to$75.73
- Conversion factor 36.0391 changed to 36.0896
- Malpractice RVU 0.08 changed to 0.09
- Work GPCI 1.045 changed to 1.049
- Practice expense GPCI 1.205 changed to 1.221
- Malpractice GPCI 1.261 changed to 1.277
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$74.36changed to$74.44
- Conversion factor 35.9996 changed to 36.0391
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$74.24changed to$74.36
- Conversion factor 35.8887 changed to 35.9996
- Work GPCI 1.048 changed to 1.045
- Malpractice GPCI 1.271 changed to 1.261
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$74.17changed to$74.24
- Conversion factor 35.8043 changed to 35.8887
- Work GPCI 1.051 changed to 1.048
- Malpractice GPCI 1.280 changed to 1.271
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$74.41changed to$74.17
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 0.99 changed to 0.98
- Malpractice RVU 0.07 changed to 0.08
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$74.04changed to$74.41
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$73.43changed to$74.04
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 0.98 changed to 0.99
- Work GPCI 1.050 changed to 1.051
- Practice expense GPCI 1.202 changed to 1.205
- Malpractice GPCI 1.205 changed to 1.280
Held through RVU15B.
January 1, 2014
RVU14A
$73.89changed to$73.43
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.09 changed to 0.98
- Work GPCI 1.049 changed to 1.050
- Practice expense GPCI 1.198 changed to 1.202
- Malpractice GPCI 1.130 changed to 1.205
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $73.89
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $67.23 | $44.81 | RVU26D |
| 2026-07-01 | $67.23 | $44.81 | RVU26C |
| 2026-04-01 | $67.23 | $44.81 | RVU26B |
| 2026-01-01 | $67.23 | $44.81 | RVU26A |
| 2025-10-01 | $66.45 | $44.47 | RVU25D |
| 2025-07-01 | $66.45 | $44.47 | RVU25C |
| 2025-04-01 | $66.45 | $44.47 | RVU25B |
| 2025-01-01 | $66.45 | $44.47 | RVU25A |
| 2024-10-01 | $68.77 | $46.16 | RVU24D |
| 2024-07-01 | $68.77 | $46.16 | RVU24C |
| 2024-04-01 | $68.77 | $46.16 | RVU24B |
| 2024-03-09 | $68.77 | $46.16 | RVU24AR |
| 2024-01-01 | $67.65 | $45.40 | RVU24A |
| 2023-10-01 | $71.33 | $47.88 | RVU23D |
| 2023-07-01 | $71.33 | $47.88 | RVU23C |
| 2023-04-01 | $71.33 | $47.88 | RVU23B |
| 2023-01-01 | $71.33 | $47.88 | RVU23A |
| 2022-10-01 | $73.75 | $49.37 | RVU22D |
| 2022-07-01 | $73.75 | $49.37 | RVU22C |
| 2022-04-01 | $73.75 | $49.37 | RVU22B |
| 2022-01-01 | $73.75 | $49.37 | RVU22A |
| 2021-10-01 | $73.91 | $49.33 | RVU21D |
| 2021-07-01 | $73.91 | $49.33 | RVU21C |
| 2021-04-01 | $73.91 | $49.33 | RVU21B |
| 2021-01-01 | $73.91 | $49.33 | RVU21A |
| 2020-10-01 | $75.73 | $50.61 | RVU20D |
| 2020-07-01 | $75.73 | $50.61 | RVU20C |
| 2020-04-01 | $75.73 | $50.61 | RVU20B |
| 2020-01-01 | $75.73 | $50.61 | RVU20A |
| 2019-10-01 | $74.44 | $49.69 | RVU19D |
| 2019-07-01 | $74.44 | $49.69 | RVU19C |
| 2019-04-01 | $74.44 | $49.69 | RVU19B |
| 2019-01-01 | $74.44 | $49.69 | RVU19A |
| 2018-10-01 | $74.36 | $49.63 | RVU18D |
| 2018-07-01 | $74.36 | $49.63 | RVU18C |
| 2018-04-01 | $74.36 | $49.63 | RVU18B |
| 2018-01-01 | $74.36 | $49.63 | RVU18AR1 |
| 2017-10-01 | $74.24 | $49.59 | RVU17D |
| 2017-07-01 | $74.24 | $49.59 | RVU17C |
| 2017-04-01 | $74.24 | $49.59 | RVU17B |
| 2017-01-01 | $74.24 | $49.59 | RVU17A |
| 2016-10-01 | $74.17 | $49.58 | RVU16D |
| 2016-07-01 | $74.17 | $49.58 | RVU16C |
| 2016-04-01 | $74.17 | $49.58 | RVU16B |
| 2016-01-01 | $74.17 | $49.58 | RVU16A |
| 2015-10-01 | $74.41 | $49.30 | RVU15D |
| 2015-07-01 | $74.41 | $49.30 | RVU15C |
| 2015-04-01 | $74.04 | $49.05 | RVU15B |
| 2015-01-01 | $74.04 | $49.05 | RVU15A |
| 2014-10-01 | $73.43 | $48.89 | RVU14D |
| 2014-07-01 | $73.43 | $48.89 | RVU14C |
| 2014-04-01 | $73.43 | $48.89 | RVU14B |
| 2014-01-01 | $73.43 | $48.89 | RVU14A |
| 2013-10-01 | $73.89 | $47.39 | RVU13D |
| 2013-07-01 | $73.89 | $47.39 | RVU13C |
| 2013-04-01 | $73.89 | $47.39 | RVU13B |
| 2013-01-01 | $73.89 | $47.39 | RVU13AR |
Where the Washington, DC area rate applies
Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.
- Washington
20553 billing questions
How is 20553 distinguished from 20552?
Count the muscles injected: use 20553 for three or more muscles and 20552 for one or two. The number of trigger points or needle passes does not determine the level.
What should the procedure note identify?
Document the muscles and injection sites, the clinical findings supporting trigger point treatment, and the procedure performed. The record should support treatment of at least three distinct muscles.
Can the medication be reported separately?
The code represents the injection procedure. A separately supplied medication may be reported when it is separately payable and the claim documentation supports it.
Can modifier 50 be used for bilateral trigger point injections?
No. CMS identifies bilateral adjustment as inappropriate for this code; report the service based on the muscles treated rather than using modifier 50.
How are other procedures in the same session paid?
Under the CMS multiple procedure reduction, the highest-valued procedure is paid in full and other procedures performed in the same session are paid at 50%.
Is same-day preoperative or postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
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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