CPT code 20553: Trigger point injection, three or more muscles2026 Medicare rate & RVUs in North Dakota
Reports medication injection into trigger points in three or more muscles to treat myofascial pain during a single session.
In North Dakota, Medicare pays $58.20 for 20553 in the office and $39.16 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 North Dakota 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. North Dakota pays $58.20. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$58.20
- Los Angeles, CA · California$65.88+$7.68
- Washington, DC area · District of Columbia$67.23+$9.03
- Miami, FL · Florida$65.22+$7.02
- Chicago, IL · Illinois$63.58+$5.38
- Manhattan, NY · New York$68.22+$10.02
- Alaska · Alaska$72.91+$14.71
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $54.54 | $37.88 |
| 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 |
| 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 North Dakota 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
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.73 | × 1.000 | 0.7300 |
| Practice expense | 0.98 | × 1.000 | 0.9800 |
| Malpractice | 0.08 | × 0.406 | 0.0325 |
| Total RVUs | 1.7425 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$58.20
Office: (0.73 × 1 + 0.98 × 1 + 0.08 × 0.406) × $33.4009 = $58.20
Facility: (0.73 × 1 + 0.41 × 1 + 0.08 × 0.406) × $33.4009 = $39.16
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 North Dakota
20553 · Office / nonfacility
$58.20
Effective 2026-10-01
The base rate is $0.90 higher than on 2025-10-01, moving from $57.30 to $58.20 (1.6%).
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
$57.30changed to$58.20
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.75 changed to 0.73
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$59.14changed to$57.30
- 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
$58.17changed to$59.14
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$60.23changed to$58.17
- Conversion factor 33.8872 changed to 32.7442
- Malpractice RVU 0.10 changed to 0.09
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$61.36changed to$60.23
- Conversion factor 34.6062 changed to 33.8872
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$61.72changed to$61.36
- 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
$64.01changed to$61.72
- Conversion factor 36.0896 changed to 34.8931
- Malpractice GPCI 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$63.90changed to$64.01
- Conversion factor 36.0391 changed to 36.0896
- Malpractice RVU 0.08 changed to 0.09
- Malpractice GPCI 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$63.83changed to$63.90
- Conversion factor 35.9996 changed to 36.0391
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$63.66changed to$63.83
- Conversion factor 35.8887 changed to 35.9996
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$63.53changed to$63.66
- Conversion factor 35.8043 changed to 35.8887
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$63.92changed to$63.53
- 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
$63.60changed to$63.92
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$63.32changed to$63.60
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 0.98 changed to 0.99
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$63.83changed to$63.32
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.09 changed to 0.98
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $63.83
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $58.20 | $39.16 | RVU26D |
| 2026-07-01 | $58.20 | $39.16 | RVU26C |
| 2026-04-01 | $58.20 | $39.16 | RVU26B |
| 2026-01-01 | $58.20 | $39.16 | RVU26A |
| 2025-10-01 | $57.30 | $38.86 | RVU25D |
| 2025-07-01 | $57.30 | $38.86 | RVU25C |
| 2025-04-01 | $57.30 | $38.86 | RVU25B |
| 2025-01-01 | $57.30 | $38.86 | RVU25A |
| 2024-10-01 | $59.14 | $40.16 | RVU24D |
| 2024-07-01 | $59.14 | $40.16 | RVU24C |
| 2024-04-01 | $59.14 | $40.16 | RVU24B |
| 2024-03-09 | $59.14 | $40.16 | RVU24AR |
| 2024-01-01 | $58.17 | $39.51 | RVU24A |
| 2023-10-01 | $60.23 | $40.92 | RVU23D |
| 2023-07-01 | $60.23 | $40.92 | RVU23C |
| 2023-04-01 | $60.23 | $40.92 | RVU23B |
| 2023-01-01 | $60.23 | $40.92 | RVU23A |
| 2022-10-01 | $61.36 | $41.63 | RVU22D |
| 2022-07-01 | $61.36 | $41.63 | RVU22C |
| 2022-04-01 | $61.36 | $41.63 | RVU22B |
| 2022-01-01 | $61.36 | $41.63 | RVU22A |
| 2021-10-01 | $61.72 | $41.83 | RVU21D |
| 2021-07-01 | $61.72 | $41.83 | RVU21C |
| 2021-04-01 | $61.72 | $41.83 | RVU21B |
| 2021-01-01 | $61.72 | $41.83 | RVU21A |
| 2020-10-01 | $64.01 | $43.44 | RVU20D |
| 2020-07-01 | $64.01 | $43.44 | RVU20C |
| 2020-04-01 | $64.01 | $43.44 | RVU20B |
| 2020-01-01 | $64.01 | $43.44 | RVU20A |
| 2019-10-01 | $63.90 | $43.36 | RVU19D |
| 2019-07-01 | $63.90 | $43.36 | RVU19C |
| 2019-04-01 | $63.90 | $43.36 | RVU19B |
| 2019-01-01 | $63.90 | $43.36 | RVU19A |
| 2018-10-01 | $63.83 | $43.31 | RVU18D |
| 2018-07-01 | $63.83 | $43.31 | RVU18C |
| 2018-04-01 | $63.83 | $43.31 | RVU18B |
| 2018-01-01 | $63.83 | $43.31 | RVU18AR1 |
| 2017-10-01 | $63.66 | $43.20 | RVU17D |
| 2017-07-01 | $63.66 | $43.20 | RVU17C |
| 2017-04-01 | $63.66 | $43.20 | RVU17B |
| 2017-01-01 | $63.66 | $43.20 | RVU17A |
| 2016-10-01 | $63.53 | $43.12 | RVU16D |
| 2016-07-01 | $63.53 | $43.12 | RVU16C |
| 2016-04-01 | $63.53 | $43.12 | RVU16B |
| 2016-01-01 | $63.53 | $43.12 | RVU16A |
| 2015-10-01 | $63.92 | $43.08 | RVU15D |
| 2015-07-01 | $63.92 | $43.08 | RVU15C |
| 2015-04-01 | $63.60 | $42.86 | RVU15B |
| 2015-01-01 | $63.60 | $42.86 | RVU15A |
| 2014-10-01 | $63.32 | $42.90 | RVU14D |
| 2014-07-01 | $63.32 | $42.90 | RVU14C |
| 2014-04-01 | $63.32 | $42.90 | RVU14B |
| 2014-01-01 | $63.32 | $42.90 | RVU14A |
| 2013-10-01 | $63.83 | $41.72 | RVU13D |
| 2013-07-01 | $63.83 | $41.72 | RVU13C |
| 2013-04-01 | $63.83 | $41.72 | RVU13B |
| 2013-01-01 | $63.83 | $41.72 | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
- Abercrombie
- Adams
- Alamo
- Alexander
- Alice
- Almont
- Alsen
- Ambrose
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
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