Billing code 20550: Tendon sheath injectionMedicare rate & RVUs in Guam
Medication injection into one tendon sheath, ligament, or aponeurosis is reported for conditions such as trigger finger, de Quervain tenosynovitis, or plantar fasciitis.
Medicare pays $63.72 for 20550 in the office in Guam (Hawaii, Guam). 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.
On this page 9 sections
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.
20550 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $63.72 | $32.96 |
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
Swap in your local Medicare rate.
Work 0.73Practice expense 0.99Malpractice 0.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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
| 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
20550 without 50 · national office
$60.46
Tendon sheath injection
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).
20550 compared with similar codes
Compare codes
20550 vs 20551 vs 20526 vs 20552 vs 20600: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 20551Tendon injection
- 20551 targets a tendon origin or insertion, such as the common extensor origin in lateral epicondylitis. 20550 targets a tendon sheath, ligament, or aponeurosis such as the plantar fascia.
- 20526Injection
- A therapeutic injection into the carpal tunnel is reported with 20526, even though flexor tendons pass through the tunnel. Use 20550 when the injection targets a tendon sheath.
- 20552Trigger point injection
- 20552 describes injection of muscle trigger points in one or two muscles for myofascial pain. 20550 is selected for injection into a tendon sheath, ligament, or aponeurosis.
- 20600Joint aspiration/injection
- 20600 describes injection into a small joint space, such as an interphalangeal joint. Use 20550 when the needle targets the surrounding tendon sheath, as in trigger finger.
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
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