CPT 20560
Global XXX ActiveNdl insj w/o njx 1 or 2 musc
CPT 20560 Billing & Documentation Guide
CPT code 20560 (Ndl insj w/o njx 1 or 2 musc) is classified under Surgery (Musculoskeletal) with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.31, a non-facility practice expense RVU of 0.42, and a malpractice RVU of 0.01, a total non-facility RVU of 0.74 and facility RVU of 0.37. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $25.49, though rates vary from $22.58 to $31.9 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 20560, 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 20560 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 20560 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 20560
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.31 | 0.31 |
| Practice Expense RVU | 0.42 | 0.05 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.74 | 0.37 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 20560
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 | $27.5 | $12.88 | $26.08 - $31.9 | 29 |
| Florida | $25.08 | $12.68 | $24.27 - $25.8 | 3 |
| Georgia | $24.16 | $12.36 | $23.27 - $25.04 | 2 |
| Illinois | $24.58 | $12.64 | $23.68 - $25.43 | 4 |
| Michigan | $23.99 | $12.4 | $23.54 - $24.45 | 2 |
| North Carolina | $23.66 | $12.13 | $23.66 - $23.66 | 1 |
| New York | $26.95 | $13.16 | $23.92 - $28.32 | 5 |
| Ohio | $23.5 | $12.22 | $23.5 - $23.5 | 1 |
| Pennsylvania | $24.55 | $12.44 | $23.55 - $25.54 | 2 |
| Texas | $24.53 | $12.37 | $23.43 - $25.51 | 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 20560
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 20560 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01991 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01992 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0230T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 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 |
Frequently Asked Questions, CPT 20560
What does CPT code 20560 mean? +
CPT code 20560 represents: Ndl insj w/o njx 1 or 2 musc. It's in the Surgery (Musculoskeletal) category with a global period of XXX.
What is the Medicare reimbursement for CPT 20560? +
The 2026 Medicare national average non-facility payment for CPT 20560 is $25.49. Rates range from $22.58 to $31.9 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 20560? +
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 20560? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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