CPT 20551
Global 000 ActiveNjx 1 tendon origin/insj
CPT 20551 Billing & Documentation Guide
CPT code 20551 (Njx 1 tendon origin/insj) is classified under Surgery (Musculoskeletal) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.73, a non-facility practice expense RVU of 1, and a malpractice RVU of 0.08, a total non-facility RVU of 1.81 and facility RVU of 0.99. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $62.03, though rates vary from $54.45 to $76.66 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 20551, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 20551 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 5 units of 20551 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 20551
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.73 | 0.73 |
| Practice Expense RVU | 1 | 0.18 |
| Malpractice RVU | 0.08 | 0.08 |
| Total RVU | 1.81 | 0.99 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 20551
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $66.23 | $33.82 | $62.84 - $76.66 | 29 |
| Florida | $63.1 | $35.62 | $60.33 - $65.91 | 3 |
| Georgia | $59.48 | $33.35 | $57.36 - $61.6 | 2 |
| Illinois | $61.85 | $35.39 | $59.05 - $64.25 | 4 |
| Michigan | $59.5 | $33.79 | $57.89 - $61.12 | 2 |
| North Carolina | $57.25 | $31.7 | $57.25 - $57.25 | 1 |
| New York | $66.43 | $35.88 | $57.99 - $70.62 | 5 |
| Ohio | $57.57 | $32.57 | $57.57 - $57.57 | 1 |
| Pennsylvania | $60.18 | $33.35 | $57.57 - $62.78 | 2 |
| Texas | $59.88 | $32.92 | $57.26 - $62.14 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 20551
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 20551 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0232T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0481T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0490T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 10030 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 10160 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 20551
What does CPT code 20551 mean? +
CPT code 20551 represents: Njx 1 tendon origin/insj. It's in the Surgery (Musculoskeletal) category with a global period of 000.
What is the Medicare reimbursement for CPT 20551? +
The 2026 Medicare national average non-facility payment for CPT 20551 is $62.03. Rates range from $54.45 to $76.66 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 20551? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 20551? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team