Billing code 20526: InjectionMedicare rate & RVUs in Washington
Report this service when medication is injected into the carpal tunnel to treat symptoms associated with median nerve compression at the wrist.
Medicare pays $89.96–$100.43 for 20526 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 20526 covers
A clinician injects medication, commonly a corticosteroid, into the carpal tunnel to treat symptoms such as pain, tingling, or numbness associated with median nerve compression. The service is typically performed by a physician or other qualified practitioner in an office or outpatient facility. The injection targets the carpal tunnel; it is not an injection into a tendon sheath or a surgical release of the tunnel.
Report the code for the treated wrist and document the indication, side, and injection performed. For treatment of both wrists, modifier 50 is paid at 150% under the CMS bilateral rule. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. The 0-day global period includes same-day preoperative and postoperative care. CMS does not pay an assistant at surgery for this service; 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.
Where 20526 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $89.96 | $49.17 |
| Seattle (King Cnty) | $100.43 | $52.89 |
How the 20526 rate is calculated
Each of 20526’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 · 20526
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.92Practice expense 1.55Malpractice 0.17
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 20526
The CMS indicators that decide how 20526 is paid alongside other services.
CMS payment indicators · 20526
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
20526 without 50 · national office
$88.18
Injection
20526-50 · Bilateral: 150%
$132.27
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).
20526 compared with similar codes
Compare codes
20526 vs 20550 vs 20527 vs 64450 vs 64721: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 20550Tendon sheath injection
- Use 20550 for an injection into a tendon sheath or ligament. Use 20526 when the injection targets the carpal tunnel.
- 20527Palmar cord injection
- 20527 describes injection of an enzyme into a palmar fascial cord, typically for Dupuytren contracture; 20526 targets the carpal tunnel.
- 64450Nerve block
- 64450 describes injection of an anesthetic agent into a peripheral nerve or branch. Choose based on the documented target and service, not simply wrist symptoms.
- 64721Carpal tunnel release
- 64721 is a surgical release of the carpal tunnel. It represents operative treatment, not a therapeutic injection.
20526 billing questions
When should I choose this code instead of 20550?
Use 20526 when the medication is injected into the carpal tunnel. Code 20550 describes an injection into a tendon sheath or ligament, such as for a tendon-related condition.
Can I report this code for injections in both wrists?
Yes. Report the bilateral service with modifier 50; CMS pays it at 150% under the bilateral rule.
Is same-day follow-up care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
How does the multiple procedure reduction affect this service?
When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and the others at 50%.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
Can the medication be reported separately?
The procedure code describes the injection service. The administered drug may be separately reported with an applicable drug code when reporting requirements are met.
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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