DecisionHealth, DecisionHealth - 2025 Issue 7 (July)
Q&A: Payer doesn’t cover 20611 but US was used anyway. Now what?
Question: If a payer has a policy that does not allow reimbursement of ultrasound guidance with joint injections (for example, CPT code 20611 [Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting]), is it OK to report, the arthrocentesis code that does not include ultrasound instead? For example, could we report 20610 for an arthroscopic knee injection even when ultrasound is used? After all, they are still doing the injection, still incurring the cost of the injected medication, they just aren’t getting paid for the ultrasound. We have a group that is having its compliance department tell them that this is fraud.
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