How much does Medicare pay for CPT 20553?

Medicare allowed an average of $52.41 per service and paid $39.53 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $294.15, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 20553?

Injection of trigger points, 3 or more muscles. It was billed 221,956 times to 122,679 Medicare beneficiaries by 3,862 providers in 2024.

Does 20553 pay differently in an office than a hospital?

Yes. The allowed amount averaged $54.24 in an office setting and $34.39 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 20553 most?

Physical Medicine and Rehabilitation, with 46,680 services from 814 clinicians. Next are Pain Management, Nurse Practitioner, Anesthesiology.

CPT 20553

Injection of trigger points, 3 or more muscles

$52.41Medicare-allowed amount per service, averaged across 221,956 services

Providers submitted

$294.15

Asking price, not received

Medicare allowed

$52.41

The fee schedule figure

Medicare paid

$39.53

Balance is patient coinsurance

Providers submitted an average of $294.15 for this code and Medicare allowed $52.41 — 5.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $39.53 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $54.24
Hospital / facility: $34.39

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 201,482 services were billed in an office setting and 20,474 in a facility.

Services: 221,956
Beneficiaries: 122,679
Providers billing it: 3,862
Total allowed: $11,632,714

What Medicare pays for CPT 20553

Across 221,956 services billed by 3,862 providers to 122,679 beneficiaries, Medicare allowed an average of $52.41 per service. That is 1.8 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 20553

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Medicine and Rehabilitation	46,680	26,622	$56.53	814
Pain Management	37,354	23,403	$53.57	674
Nurse Practitioner	31,723	14,095	$47.06	518
Anesthesiology	25,587	16,190	$52.06	526
Physician Assistant	23,666	11,339	$47.14	414
Interventional Pain Management	16,082	10,387	$54.80	305
Neurology	14,305	6,660	$49.12	203
Internal Medicine	5,175	2,300	$59.12	55
Orthopedic Surgery	4,452	2,857	$56.31	57
Family Practice	4,234	2,041	$57.74	79
Rheumatology	3,311	1,997	$55.07	52
Emergency Medicine	1,334	563	$60.67	15
Sports Medicine	1,299	913	$59.97	34
General Practice	1,080	336	$58.75	15
Ambulatory Surgical Center	887	647	$28.04	17

20553 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	32,050	$56.32	$38.93	462
New York	25,827	$61.75	$41.61	370
Florida	21,771	$54.52	$41.04	352
Arizona	15,296	$48.51	$37.58	189
Texas	11,882	$51.08	$39.45	241
Pennsylvania	9,223	$51.05	$38.89	182
New Jersey	9,112	$60.25	$42.35	141
Massachusetts	7,228	$49.39	$34.77	127
Illinois	6,434	$52.10	$38.12	131
Maryland	5,391	$51.38	$37.43	77
North Carolina	5,167	$46.93	$37.05	122
Virginia	5,019	$51.14	$38.66	105
Ohio	4,963	$43.61	$33.68	102
Nevada	4,564	$53.58	$41.10	64
Colorado	4,094	$49.68	$37.04	62
Kentucky	3,100	$48.68	$38.34	71
Michigan	3,069	$46.67	$35.09	67
Missouri	3,030	$45.08	$35.63	64
Minnesota	2,856	$43.48	$32.47	71
Utah	2,731	$52.15	$39.94	55
Connecticut	2,560	$56.57	$39.95	40
South Carolina	2,483	$45.81	$36.82	45
Georgia	2,397	$51.57	$39.92	70
Tennessee	2,384	$46.74	$38.05	67
Louisiana	2,259	$44.64	$37.54	30
Wisconsin	2,244	$42.57	$33.20	67
Washington	2,230	$51.04	$37.01	45
Mississippi	1,926	$42.76	$35.70	31
Nebraska	1,817	$48.11	$39.84	31
Iowa	1,659	$39.81	$31.85	30
New Hampshire	1,462	$46.09	$34.08	29
West Virginia	1,445	$41.46	$32.60	20
Indiana	1,430	$46.03	$36.88	32
Alabama	1,335	$49.61	$41.59	32
Arkansas	1,308	$50.65	$42.12	26
Kansas	1,291	$42.71	$34.46	26
New Mexico	1,266	$44.86	$35.50	23
Oregon	1,039	$50.71	$39.57	28
Oklahoma	885	$50.49	$40.21	19
Maine	812	$47.60	$34.96	14
South Dakota	715	$40.27	$30.32	14
North Dakota	702	$34.40	$26.65	11
Delaware	649	$53.23	$41.48	12
Montana	526	$42.17	$29.65	13
Alaska	434	$74.20	$44.78	5
Rhode Island	405	$45.82	$34.67	9
Wyoming	396	$53.42	$38.85	7
Idaho	385	$38.33	$30.34	12
District of Columbia	376	$55.99	$38.53	9
Puerto Rico	113	$41.15	$32.58	3
Hawaii	111	$60.39	$41.19	4
Guam	58	$64.87	$41.32	1
Vermont	47	$31.81	$23.98	2

Related codes

20550Injection into tendon or ligament$50.46
20552Injection of trigger points$44.76
20551Injection into tendon at attachment to bone or muscle$41.92
20526Injection of carpal tunnel$88.67
20527Injection of medication into palm$76.06

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.