Enzyme injection into a palmar fascial cord to dissolve Dupuytren's contracture tissue — day-one component of a two-stage CCH treatment protocol.

Verified May 8, 2026 · 5 sources ↓

Medicare: $94.19
Total RVUs: 2.82
Global, days: 0
Region: Hand

Drawn from NimblercmCMSAAPCMdclarity

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Confirm Dupuytren's cord is palpable and document the specific finger(s) and cord(s) targeted
Record which hand was injected (right, left, or bilateral) and the injection site anatomy
Document the enzyme used (e.g., collagenase clostridium histolyticum) and dose administered
Note the degree of contracture at the MCP or PIP joint to support medical necessity
Record that day-one injection and day-two manipulation are planned as a two-stage protocol
Prior authorization documentation or reference number if payer requires it before injection

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

50 Bilateral procedure 51 Multiple procedures 59 Distinct service LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 20527 covers the injection of an enzyme (collagenase clostridium histolyticum, commercially Xiaflex) directly into the fibrous cord causing Dupuytren's contracture. This is strictly the day-one injection service. The patient returns on a separate day for cord manipulation, reported under CPT 26341, which carries a 10-day global period. CPT 20527 itself carries a 000 global period — no pre- or post-op visits are bundled.

The supporting drug (J-code for collagenase) is billed separately from the injection procedure code. Many commercial payers cover this service but enforce quantity limits and prior authorization requirements — confirm cord-level coverage policies before scheduling, as coverage limitations vary by payer and plan. ICD-10 M72.0 is the supported diagnosis code for Dupuytren's contracture per Noridian LCD A57079.

Side laterality matters: bill RT or LT to identify the treated hand. If both hands are injected in the same session, use modifier 50. The HOPD and ASC payment differentials are significant — see the Site of Service comparison. The vast majority of these injections occur in an office setting (POS 11).

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.98
Practice expense RVU	1.65
Malpractice RVU	0.19
Total RVU	2.82
Medicare national rate	$94.19
Global period	0 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$94.19
HOPD (APC 5441) Hospital outpatient department	$313.60
ASC (PI P3) Ambulatory surgical center (freestanding)	$55.39

Common denial reasons

The recurring reasons claims for CPT 20527 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing or expired prior authorization — most payers require PA for Xiaflex before injection day
J-code for collagenase billed without the supporting 20527 procedure code, triggering an unbundling edit
Laterality not specified — claim submitted without RT or LT modifier causing processing rejection
ICD-10 code mismatch — diagnosis other than M72.0 submitted, failing LCD medical necessity criteria
26341 billed same day as 20527 — manipulation must be on a separate date of service
Cord not documented as palpable — payers deny when clinical notes don't confirm a discrete cord

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 20527 and 26341 be billed on the same date of service?

No. 20527 is the day-one injection; 26341 is the day-two manipulation. They must be on separate dates of service. Billing both on the same day will result in denial.

02Which ICD-10 code supports 20527 under Medicare LCD?

M72.0 is the required diagnosis code per Noridian LCD Article A57079. Using a non-covered diagnosis will trigger a medical necessity denial.

03How do you bill the collagenase drug separately from the injection procedure?

Report the appropriate J-code for collagenase clostridium histolyticum on the same claim as 20527. The drug and the injection procedure code are distinct line items — do not fold the drug cost into the procedure.

04If both hands are injected in the same session, how is that billed?

Append modifier 50 to 20527 for a bilateral same-session injection. Alternatively, some payers prefer separate line items with LT and RT. Check your payer's bilateral billing preference before submitting.

05Does the 000 global period mean an E/M can be billed on the same day as 20527?

A 000 global period means same-day E/M is technically billable, but only if it's a separately identifiable decision-making service. Append modifier 25 to the E/M. Routine pre-injection assessment is not separately billable.

06Is prior authorization required for 20527?

Most commercial payers require prior authorization for Xiaflex injections. Auth requirements and coverage limits vary by payer and plan — verify before scheduling the injection day.

07Can a custom splint applied on day two be billed separately?

Yes. Custom-fabricated splint application on the manipulation day (26341) is separately reportable. The splint falls within the 10-day global for 26341 only if it is a routine post-manipulation dressing — custom fabrication is distinct.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the cord location (finger, MCP vs. PIP joint), laterality, contracture severity in degrees, enzyme name and dose, and the planned two-stage protocol from dictation. That documentation directly satisfies payer medical necessity criteria for M72.0 and prevents denials tied to missing cord-palpability language or absent laterality.

See how Mira captures CPT 20527 documentation