Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), with ultrasound guidance, permanent recording and reporting

CPT 20611 is the billing code for "Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), with ultrasound guidance, permanent recording and reporting". For arthrocentesis, aspiration and/or injection of major joint or bursa with ultrasound guidance

Medicare pays approximately $96.39 for CPT 20611 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 20611 has a total RVU of 7.58, broken down as: Work RVU 2.80, Practice Expense RVU 4.50, and Malpractice RVU 0.28. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 20611 include: Indication for injection or aspiration; Joint or bursa location; Ultrasound guidance used; Medication injected (if applicable). Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 20611: Includes arthrocentesis and/or injection. Includes ultrasound guidance Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 20611 include: 50 (Bilateral procedure when both sides injected same session), 51 (Multiple procedures performed same session), LT (Left side procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 20611 is 15-25 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.