CPT 20552: Trigger Point Injection for Myofascial Pain
Medicare pays $53 and commercial payers pay $261 on average nationally for this procedure.
CPT code 20552 describes a trigger point injection procedure in which an anesthetic or corticosteroid is injected into a painful muscle knot to relieve localized myofascial pain; this is typically an outpatient injection procedure performed in an office, clinic, or ambulatory care setting and may target areas such as the neck, back, or extremity muscles.
For related coverage guidance, see recent payer policy updates: Hip Arthroplasty (partial and total hip replacement), Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing), Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty).
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National Reimbursement Benchmarks
Medicare’s average rate for CPT 20552 is $53.30, while BUCA’s mean commercial rate sits at $261.20, indicating BUCA pays roughly $207.90 more on average than Medicare. This gap highlights a substantial divergence between a large public payer and a representative commercial benchmark, with implications for overall market positioning and expected cash collections where commercial plans dominate.
Dispersion (P75 minus P25) varies notably: Blue Cross Blue Shield shows the widest spread at $147.20 (P75 $494.40 minus P25 $347.20), followed by UnitedHealth Group with a range of $48.40 (P75 $106.20 minus P25 $53.80). Aetna is relatively tight with a range of $37.10, and Cigna’s interquartile range is $46.20. BUCA’s interquartile spread is $103.50 and Medicare’s IQR is $5.00, making Medicare the tightest and Blue Cross Blue Shield the most dispersed payer.