Joint injections are one of the most frequently performed procedures in orthopedic practices. It won’t be wrong to call them the “bread-and-butter” procedures. So, practices can’t afford to get their claims denied. Otherwise, they can lose a significant portion of their revenue.
CPT code 20611 represents one such joint injection. However, many billers make mistakes while filing claims for it. That’s why we have included this in our series of CPT code guides. By the end of this guide, you will have all the necessary information to file this code successfully.
So, let’s start.
CPT Code 20611 – Description
CPT code 20611 is defined as:
“Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting.”
The definition can be hard to understand, so let’s break it down into simple points:
- Procedure Type: It covers arthrocentesis (draining fluid), aspiration (removing fluid for analysis), or injection (delivering medication, like corticosteroids).
- Anatomic Location: It is restricted to a major joint or bursa. In CPT terminology, major joints specifically include the shoulder, hip, and knee, as well as the subacromial bursa.
- Guidance: The procedure must be performed with ultrasound guidance. Imaging is required to precisely locate the injection area.
- Documentation: This is the most overlooked requirement. The descriptor explicitly mandates “permanent recording and reporting.” This means you must save the ultrasound images to the patient’s medical record and produce a written report of the findings.
- Purpose: Therapeutic or diagnostic. The procedure may be performed to administer a therapeutic drug to relieve pain and inflammation. Or to remove synovial fluid and send it for further examination and diagnose an infection.
A point of confusion for many billers that leads to denials is distinguishing between CPT 20611 and its counterpart, CPT 20610. Please note that CPT codes 20611 and 20610 represent the exact same procedure on the same major joints. The only difference is imaging. 20610 does not include imaging, while 20611 does.
Therefore, if you use ultrasound for a knee injection, you must bill 20611. If you palpate the knee and inject without imaging, 20610 will be applicable.
Scenarios Where CPT Code 20611 is Applicable
To make things clearer, let’s look at a couple of real-world scenarios in which CPT code 20611 can be used:
Reiter’s Disease
Suppose a patient comes to a clinic with severe left hip pain and limited mobility following a recent gastrointestinal infection. The patient reports persistent joint swelling and stiffness that hasn’t responded to oral anti-inflammatory medications prescribed by the previous provider. Upon examination and reviewing laboratory results showing elevated inflammatory markers, the physician diagnosed Reiter’s disease affecting the left hip.
To provide therapeutic relief and reduce inflammation, the physician performs an arthrocentesis with corticosteroid injection into the left hip joint under ultrasound guidance. The billing department can bill the procedure with CPT code 20611 and ICD-10 M02.352 diagnosis code.
Idiopathic Gout
Suppose a patient comes to a clinic complaining of intense right hip pain and noticeable swelling. The patient mentions he has already tried diet changes and medications, but nothing has really helped. After examining the patient and checking his lab work, which showed high uric acid levels, the physician diagnosed him with idiopathic gout in the right hip.
To help ease the pain and reduce the swelling, the physician performs a joint aspiration and injects a corticosteroid into the right hip using ultrasound for guidance. In this case, the billing department can bill the procedure with CPT code 20611 and ICD-10 M10.051 diagnosis code.
Applicable Modifiers for CPT Code 20611
The following modifiers are frequently used with CPT code 20611:
| Modifier | Description | Application |
|---|---|---|
| 50 | Bilateral Procedure | Apply to CPT 20611 when performing arthrocentesis on both sides of the body in the same session. |
| LT | Left Side Procedure | Use when the procedure is performed on the left joint. |
| RT | Right Side Procedure | Use when the procedure is performed on the right joint. |
CPT Code 20611 – Billing & Reimbursement Guidelines
The following are some important points to consider before submitting claims for CPT code 20611:
The “One Unit Per Joint” Rule
It is vital to remember that 20611 is reported once per joint, regardless of how many injections or aspirations are performed in that single joint. If a provider aspirates fluid from the medial aspect of the knee and then injects a steroid into the lateral aspect of the same knee during the same session, this constitutes only one unit of 20611.
Cost of Medicines
Please note that code 20611 only provides reimbursement for the procedural services (the services of the provider). It does not include the cost of injected drugs. You will have to bill for the drugs separately via the appropriate HCPCS code.
You can find the list of frequently used drugs with CPT code 20611 in the CMS guide.
Documentation Requirements
Providing detailed documentation with your claims is a must if you want fair reimbursement. Not only should your medical records be detailed, but they must also be precise.
The following are some essential things to mention:
- Specific joint or bursa treated (e.g., “tibiofemoral and/or patellofemoral joints of the right knee” rather than just “knee”).
- Permanent images (digital or print) stored in the patient record.
- Documentation of normal anatomy or pathological findings.
- Proof of failed initial conservative treatment.
- Medication type and dosage administered.
- Procedural details, including needle size, injection technique, and patient response.
Medicare Reimbursement Rate
According to the Medicare data released for 2026, the national average Medicare
Reimbursement rates for CPT code 20611 are:
- Facility setting (hospital outpatient/ASC): $50.10
- Non-facility setting (office): $104.21
These prices only represent the national average rates. The actual reimbursement rates vary for each Medicare Administrative Contractor (MAC) locality. So, use the PFS Lookup Tool to confirm the exact amount for your MAC before filing the claim.
Wrapping Up
In this guide, we tried to simplify CPT code 20611 for you. It is one of the most used codes in orthopedic practices and needs proper documentation to be reimbursed. However, denials can occur even if all the basic guidelines are followed.
If you are having trouble with medical coding or want to outsource your non-clinical operations, you can always count on our expert orthopedic billing services.
