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CPT 20527: Collagenase Injection for Dupuytren's Contracture

CPT code 20527 identifies an enzymatic injection procedure used to treat Dupuytren's contracture by injecting an enzyme, such as collagenase, directly into the palmar fascial cord to dissolve the contracted tissue. This procedure offers a less invasive alternative to open fasciectomy and is widely used in outpatient and office settings. Nationally, the code is relevant for procedural coding, coverage determination, and cost analyses related to hand surgery and minimally invasive soft-tissue interventions.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for use of the code, payer coverage considerations, and common billing practices tied to outpatient enzymatic treatment for hand contractures. The publication summarizes typical sites of service, expected service type, and common modifiers and ancillary coding considerations where available. It also outlines benchmarking and policy topics readers should expect, including reimbursement patterns, prior authorization trends, and comparative utilization versus surgical alternatives.

This summary is intended for a national audience of coding professionals, clinical managers, and policy analysts seeking concise information on coding, clinical application, and payer engagement for enzymatic treatment of Dupuytren's contracture.

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Billing Code Overview

CPT code 20527 describes an injection of an enzyme, such as collagenase, into the palmar fascial cord to dissolve an abnormal tissue knot of the palmar fascia, commonly known as Dupuytren's contracture. This is a therapeutic, minimally invasive procedure intended to enzymatically weaken and rupture the contracted cord.

Service Type: Enzymatic injection for soft-tissue contracture release

Typical Site of Service: Outpatient clinic or physician office

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CPT 20527: Collagenase Injection for Dupuytren's Contracture

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Billing Code Overview

Service Type: Enzymatic injection for soft-tissue contracture release

Typical Site of Service: Outpatient clinic or physician office

Clinical & Coding Specifications

Clinical Context

A 68-year-old right-hand-dominant male with progressive palmar fascial thickening presents to an outpatient hand clinic with a fixed flexion contracture of the ring and small fingers limiting hygiene and activities of daily living. The diagnosis is Dupuytren's contracture with a palpable palmar cord and contracture at the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. After evaluation by a hand surgeon or hand-specialty advanced practice provider, conservative measures (observation, splinting) were discussed and the decision was made to perform enzymatic fasciotomy using a collagenase injection into the palmar fascial cord.

The typical clinical workflow: referral or clinic evaluation → focused hand exam and documentation of range of motion and functional impairment → informed consent and discussion of risks/benefits → procedural consent and scheduling for office-based injection → administration of CPT 20527 in an ambulatory clinic or outpatient procedure room with local anesthesia as needed → post-injection instructions, scheduling of manipulation if indicated (typically within 24–72 hours), and follow-up for wound care and hand therapy. Typical site of service is an outpatient clinic or ambulatory surgery center. The service type is a therapeutic, office-based or ambulatory procedure for enzymatic dissolution of a palmar fascial cord.

Coding Specifications

Modifier	Description	When to Use
`RT`	Right side	When the injection is performed on the right hand/fingers.
`LT`	Left side	When the injection is performed on the left hand/fingers.
`50`	Bilateral procedure	When both hands are treated during the same encounter and payer allows bilateral reporting.
`59`	Distinct procedural service	When there is a separate, distinct procedure on the same date (rare for `CPT 20527`) to indicate a different anatomical site or separate service.
`52`	Reduced services	When the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	When the procedure is started but terminated for patient-related or unforeseen circumstances before completion.
`23`	Unusual anesthesia	When significant or unusual anesthesia is required beyond local infiltration for patient tolerance.
`22`	Increased procedural services	When the procedure required substantially greater resources or time than typical, with supporting documentation.
`76`	Repeat procedure by same physician (use of `76` not listed in raw modifiers; Data not available in the input.)	Data not available in the input.
`57`	Decision for surgery (use of `57` not listed in raw modifiers; Data not available in the input.)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207LH0000X`	Hand Surgery	Hand surgeons commonly perform and manage care including injections and subsequent manipulation.
`207RH0000X`	Orthopedic Surgery	Orthopedic hand specialists provide diagnosis and office-based treatment of Dupuytren's contracture.
`207XS0102X`	Plastic Surgery (Hand/Upper Extremity)	Plastic surgeons who specialize in hand reconstruction may perform enzymatic injections and follow-up.
`363LP0800X`	Physician Assistant	PAs in hand surgery clinics often assist, evaluate, and may perform injections under supervision per state law.
`363LA2200X`	Nurse Practitioner	NPs in specialty clinics may perform the injection and document the procedure per scope of practice.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M72.0`	Palmar fascial fibromatosis [Dupuytren]	Primary diagnostic code for Dupuytren's contracture; direct indication for `CPT 20527`.
`M20.2`	Flexion deformity of finger(s) (acquired)	Used when documenting the resultant flexion contracture of the digits associated with Dupuytren's disease.
`M77.4`	Plantar fasciitis (use as comorbidity)	Not directly related but may be present as a comorbid fibromatosis (Ledderhose disease) in patients with palmar fibromatosis.
`M89.81`	Acquired deformity of hand	Used when specifying acquired hand deformity when a more specific code is not applicable.
`Z79.899`	Other long term (current) drug therapy	May be used to indicate ongoing medication therapy, for example when documenting chronic treatments or comorbid conditions that affect procedural planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20526`	Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fasciitis") — therapeutic; up to 3 tendons/ligaments	Occasionally used for injections of tendon sheaths or adjacent structures when differential treatment is required; not a substitute for collagenase injection of palmar fascial cords.
`26123`	Fasciotomy, palmar; fasciectomy, partial (including skin grafts when performed)	Represents open surgical fasciectomy that may be performed if enzymatic treatment fails or contracture is advanced.
`26040`	Fasciotomy; palmar (initial)	Surgical release of palmar fascia; alternative operative treatment for Dupuytren's contracture when collagenase injection is not appropriate.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee)	Reflects injection/aspiration technique codes; not directly for palmar cord but relevant for billing comparisons of injection procedures.
`99070`	Supplies and materials (eg, drugs, appliances, supplies) provided by the physician over and above those usually included with the office visit or other services	Used to report additional supply costs such as the collagenase drug if payer policy allows separate supply billing.

CPT 20500: Sinus Tract Therapeutic Injection

CPT-20501-SINUS-TRACT-CONTRAST-INJECTION-DIAGNOSTIC

CPT 20501: Diagnostic Injection of Sinus Tract with Imaging Guidance

CPT-20520-FOREIGN-BODY-REMOVAL-MUSCLE-TENDON-SHEATH

CPT 20520: Removal of Foreign Body from Muscle or Tendon Sheath

CPT-20525-DEEP-FOREIGN-BODY-REMOVAL-MUSCLE-TENDON-SHEATH

CPT 20525: Deep Foreign Body Removal from Muscle or Tendon Sheath

CPT-20526-CARPAL-TUNNEL-INJECTION-SHORT-TERM-RELIEF

CPT 20526: Carpal Tunnel Injection for Short-Term Symptom Relief

CPT-20550-TENDON-OR-LIGAMENT-INJECTION-APONEUROSIS-TREATMENT

CPT 20550: Tendon or Ligament Injection for Aponeurosis

CPT-20551-TENDON-ORIGIN-INSERTION-INJECTION

CPT 20551: Therapeutic Injection at Tendon Origin or Insertion

CPT-20552-TRIGGER-POINT-INJECTION-ONE-OR-TWO-MUSCLES

CPT 20552: Trigger Point Injection, One or Two Muscles

CPT-20553-TRIGGER-POINT-INJECTION-THREE-OR-MORE-MUSCLES

CPT 20553: Trigger Point Injection, Three or More Muscles

CPT-20555-INTERSTITIAL-BRACHYTHERAPY-RADIOELEMENT-APPLICATION

CPT 20555: Interstitial Radioelement Application (Brachytherapy)

Showing 1–10 of 41

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`RT`	Right side	When the injection is performed on the right hand/fingers.
`LT`	Left side	When the injection is performed on the left hand/fingers.
`50`	Bilateral procedure	When both hands are treated during the same encounter and payer allows bilateral reporting.
`59`	Distinct procedural service	When there is a separate, distinct procedure on the same date (rare for `CPT 20527`) to indicate a different anatomical site or separate service.
`52`	Reduced services	When the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	When the procedure is started but terminated for patient-related or unforeseen circumstances before completion.
`23`	Unusual anesthesia	When significant or unusual anesthesia is required beyond local infiltration for patient tolerance.
`22`	Increased procedural services	When the procedure required substantially greater resources or time than typical, with supporting documentation.
`76`	Repeat procedure by same physician (use of `76` not listed in raw modifiers; Data not available in the input.)	Data not available in the input.
`57`	Decision for surgery (use of `57` not listed in raw modifiers; Data not available in the input.)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207LH0000X`	Hand Surgery	Hand surgeons commonly perform and manage care including injections and subsequent manipulation.
`207RH0000X`	Orthopedic Surgery	Orthopedic hand specialists provide diagnosis and office-based treatment of Dupuytren's contracture.
`207XS0102X`	Plastic Surgery (Hand/Upper Extremity)	Plastic surgeons who specialize in hand reconstruction may perform enzymatic injections and follow-up.
`363LP0800X`	Physician Assistant	PAs in hand surgery clinics often assist, evaluate, and may perform injections under supervision per state law.
`363LA2200X`	Nurse Practitioner	NPs in specialty clinics may perform the injection and document the procedure per scope of practice.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M72.0`	Palmar fascial fibromatosis [Dupuytren]	Primary diagnostic code for Dupuytren's contracture; direct indication for `CPT 20527`.
`M20.2`	Flexion deformity of finger(s) (acquired)	Used when documenting the resultant flexion contracture of the digits associated with Dupuytren's disease.
`M77.4`	Plantar fasciitis (use as comorbidity)	Not directly related but may be present as a comorbid fibromatosis (Ledderhose disease) in patients with palmar fibromatosis.
`M89.81`	Acquired deformity of hand	Used when specifying acquired hand deformity when a more specific code is not applicable.
`Z79.899`	Other long term (current) drug therapy	May be used to indicate ongoing medication therapy, for example when documenting chronic treatments or comorbid conditions that affect procedural planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20526`	Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fasciitis") — therapeutic; up to 3 tendons/ligaments	Occasionally used for injections of tendon sheaths or adjacent structures when differential treatment is required; not a substitute for collagenase injection of palmar fascial cords.
`26123`	Fasciotomy, palmar; fasciectomy, partial (including skin grafts when performed)	Represents open surgical fasciectomy that may be performed if enzymatic treatment fails or contracture is advanced.
`26040`	Fasciotomy; palmar (initial)	Surgical release of palmar fascia; alternative operative treatment for Dupuytren's contracture when collagenase injection is not appropriate.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee)	Reflects injection/aspiration technique codes; not directly for palmar cord but relevant for billing comparisons of injection procedures.
`99070`	Supplies and materials (eg, drugs, appliances, supplies) provided by the physician over and above those usually included with the office visit or other services	Used to report additional supply costs such as the collagenase drug if payer policy allows separate supply billing.

CPT 20500: Sinus Tract Therapeutic Injection

CPT-20501-SINUS-TRACT-CONTRAST-INJECTION-DIAGNOSTIC

CPT 20501: Diagnostic Injection of Sinus Tract with Imaging Guidance

CPT-20520-FOREIGN-BODY-REMOVAL-MUSCLE-TENDON-SHEATH

CPT 20520: Removal of Foreign Body from Muscle or Tendon Sheath

CPT-20525-DEEP-FOREIGN-BODY-REMOVAL-MUSCLE-TENDON-SHEATH

CPT 20525: Deep Foreign Body Removal from Muscle or Tendon Sheath

CPT-20526-CARPAL-TUNNEL-INJECTION-SHORT-TERM-RELIEF

CPT 20526: Carpal Tunnel Injection for Short-Term Symptom Relief

CPT-20550-TENDON-OR-LIGAMENT-INJECTION-APONEUROSIS-TREATMENT

CPT 20550: Tendon or Ligament Injection for Aponeurosis

CPT-20551-TENDON-ORIGIN-INSERTION-INJECTION

CPT 20551: Therapeutic Injection at Tendon Origin or Insertion

CPT-20552-TRIGGER-POINT-INJECTION-ONE-OR-TWO-MUSCLES

CPT 20552: Trigger Point Injection, One or Two Muscles

CPT-20553-TRIGGER-POINT-INJECTION-THREE-OR-MORE-MUSCLES

CPT 20553: Trigger Point Injection, Three or More Muscles

CPT-20555-INTERSTITIAL-BRACHYTHERAPY-RADIOELEMENT-APPLICATION

CPT 20555: Interstitial Radioelement Application (Brachytherapy)

Showing 1–10 of 41

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 20527: Collagenase Injection for Dupuytren's Contracture

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Billing Code Overview

OpenPayer

CPT 20527: Collagenase Injection for Dupuytren's Contracture

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References