Are All Injections Billable?

Question:

Patient wants doctor to do injection of BPC 157 [Peptide] which the patient buys and provides. Can I bill 96372 for this service? The BPC 157 is not FDA approved and is considered experimental. Can I bill this service since no J code is available?

Answer:

While CPT 96372 technically describes the mechanical act of giving an injection, billing a payor for non-FDA-approved substances, as you've described, is not recommended. 

*This response is based on the best information available as of 09/03/26.

Interlaminar vs. Transforaminal Injections

Question:

If my physician does an interlaminar epidural steroid injection with imaging, should I be coding this as a 62321 or 62323? I know the guidelines state if a Transforaminal is done at that level to code as a 64479, but it doesn't state specifically for the interlaminar approach.

Answer:

Ensuring you select the correct injection CPT code is vitally important.

An interlaminar epidural steroid injection, whether performed for diagnostic or therapeutic purposes, is coded to either CPT 62321 or 62323, depending on the anatomic area.

Please note that CPT 62321 is for a cervical or thoracic injection, and CPT 62323 is for a lumbar or sacral (caudal) injection. Both CPT codes include needle or catheter placement with imaging guidance (i.e., fluoroscopy or CT). They do not include neurolytic substances. A transforaminal is coded by CPT 64479.

*This response is based on the best information available as of 08/27/26.

Diagnostic Ultrasound Followed by Ultrasound Guided Injection

Question:

We have a Pain Interventionalist performing diagnostic MSK ultrasounds, followed by an ultrasound guided injection. We bill both codes but the claims keep bundling. Is there a way to avoid this?

Answer:

Thank you so much for reaching out with your question. Based on your question, KZA is happy to share the general guidelines for Ultrasound billing with you. An ultrasound-guided injection, for example CPT 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting, involves a focused ultrasound assessment. This includes capturing, labeling, and interpreting images from different angles around the affected area. The goal is to find the best approach for the injection, while noting normal anatomy and any signs of issues. Imaging helps guide the needle safely into the joint or bursa, avoiding bones, blood vessels, and other sensitive structures. Afterward, the findings are carefully documented in the patient’s chart to keep everyone informed. If a diagnostic ultrasound is performed at the same location, it’s included as part of the ultrasound-guided procedure.  

If a diagnostic ultrasound is performed at the separate anatomic location, a modifier 59 or X{ESPU} modifier may be appropriate. Please know that this will be under high scrutiny with the payors. 

KZA has free KZA KAST podcasts on both modifier 59 and the subset X {ESPU} for additional information on the appropriate application of these modifiers. 

Modifier 59 - Part 1

https://monday.transistor.fm/episodes/modifier-59-part-1

Subset Modifier XE

https://monday.transistor.fm/episodes/subset-modifier-xe

*This response is based on the best information available as of 07/09/26.

SI Joint Injection in an ASC Coding

Question:

Does Medicare require a different code than 27096 for SI joint injections billed to an ASC?

Answer:

Yes. For ASC (Ambulatory Surgery Center) billing, Medicare requires HCPCS code G0260 for facility billing instead of 27096. For professional (physician) billing, use 27096. Remember to always verify payor-specific requirements.

*This response is based on the best information available as of 06/04/26.

Lidocaine and/or Bupivacaine

Question:

When billing corticosteroid injection in office, can you bill out lidocaine and/or bupivacaine separately or are they bundled within the injection?

Answer:

Lidocaine and/or bupivacaine are not separately billable when used with a corticosteroid injection in the office. CPT states that local infiltration of anesthesia is included in the global surgical package. CMS states that any anesthesia provided by the operating surgeon is also included. 

*This response is based on the best information available as of 05/07/26.

Interspinous Ligament Injection

Question:

Our doctor performed an interspinous ligament injection L3-4 for the diagnosis of lumbar interspinous bursitis. I billed CPT 20550 but was unable to code the anatomical modifier LT or RT because it was injected directly into the ligament. Would CPT code 22899 be more appropriate, as 20550 requires an anatomical modifier?

Answer:

If an interspinous ligament injection is performed due to bursitis, the correct CPT code would be 20550. Unlisted CPT codes are utilized when a specific CPT code does not exist.

A specific CPT code exists for this procedure therefore, 20550 is used. 

*This response is based on the best information available as of 04/02/26.