20611

Aspiration or injection of a major joint or bursa performed under real-time ultrasound guidance, with permanent image documentation.

Verified May 8, 2026 · 5 sources ↓

Medicare: $104.21
Total RVUs: 3.12
Global, days: 0
Region: General

Drawn from CMSMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Named joint or bursa injected or aspirated (e.g., right knee, left subacromial bursa)
Real-time ultrasound guidance used throughout the procedure — not just for localization
Permanent ultrasound images stored in the medical record with date, laterality, and provider identification
Indication for the procedure (diagnosis code tied to documented clinical findings)
Volume and name of any injectable material administered (corticosteroid, hyaluronic acid, PRP, etc.)
Separate, distinct documentation supporting any same-day E&M if modifier 25 is appended

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 50 Bilateral procedure 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 20611 covers needle-based drainage or injection of a large joint or bursa — knee, shoulder, hip, ankle, wrist, or elbow — when the provider uses ultrasound guidance throughout the procedure and permanently records the images. The ultrasound component is bundled into the code; do not separately bill 76942 (ultrasonic guidance for needle placement) alongside 20611. That pairing is an NCCI edit violation.

The 000-day global period means each encounter stands alone — no post-procedure visits are bundled. An E&M on the same date requires modifier 25 to survive adjudication, and the visit note must document a separately identifiable medical decision beyond the injection itself. Common injectables include corticosteroids, hyaluronic acid (viscosupplementation), and platelet-rich plasma; the drug is billed separately under the applicable J-code or HCPCS code when covered.

Site of service matters significantly here. The gap between HOPD and ASC payment rates reflects facility cost differences, not procedure differences — the physician's professional fee is the same regardless of setting. When billing bilaterally in a single session, report 20611-50 or use LT/RT on separate lines per payer preference; most commercial payers reduce the second-side payment by 50%.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.07
Practice expense RVU	1.91
Malpractice RVU	0.14
Total RVU	3.12
Medicare national rate	$104.21
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	$104.21
HOPD (APC 5441) Hospital outpatient department	$313.60
ASC (PI P3) Ambulatory surgical center (freestanding)	$64.11

Common denial reasons

The recurring reasons claims for CPT 20611 get rejected.

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

76942 billed alongside 20611 — ultrasound guidance is already included; NCCI bundles the pair
Missing permanent image documentation — payers treat absence of saved ultrasound images as failure to meet code requirements
Same-day E&M denied for lacking modifier 25 or for note that mirrors the procedure note without separate medical decision-making
Hyaluronic acid (viscosupplementation) J-codes denied for missing LCD coverage criteria documentation, particularly for Medicare
Laterality missing — claims without LT, RT, or bilateral modifier on paired-joint injections are frequently rejected or suspended

Frequently asked questions

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

01Can I bill 76942 in addition to 20611 for the ultrasound guidance?

No. Ultrasound guidance is bundled into 20611. Billing 76942 separately is an NCCI edit violation and will be denied or recouped on audit.

02What modifier do I use when injecting both knees in the same session?

Bill 20611-50 for a bilateral procedure, or submit two lines with LT and RT. Most payers automatically reduce the second-side payment by 50% — check your contract for exact terms, as commercial payer rules vary.

03Do I need modifier 25 if I see the patient in the office and then inject the same day?

Yes. Append modifier 25 to the E&M and ensure the office note documents a separately identifiable history, exam, and medical decision beyond the injection. A note that reads only as pre-injection assessment won't survive an audit.

04How does the 000-day global period affect same-day or next-day billing?

The 000-day global covers only the day of the procedure. Any visit the following day or later is billable without a modifier. A same-day E&M still requires modifier 25.

05Is a J-code for the injected drug billed separately from 20611?

Yes. The drug is not included in 20611. Bill the applicable J-code (e.g., J3301 for triamcinolone, J7321–J7324 series for hyaluronic acid products) in addition to the procedure code, subject to payer coverage policy and, for Medicare, applicable LCD criteria.

06Can 20611 be billed for a small joint like a finger or toe?

No. 20611 is for large joints and bursae. Small joints without ultrasound guidance use 20600; with ultrasound guidance use 20604. Using 20611 for a small joint is a coding error that auditors flag.

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 joint name, laterality, needle approach, ultrasound guidance confirmation, image storage notation, and injectable agent with volume directly from dictation. That structured capture prevents the two most common 20611 denials: missing permanent image documentation and an unspecified injection site that triggers manual review.

See how Mira captures CPT 20611 documentation