CPT 20611 · Peripheral Joint/Tendon
Major Joint Injection (with US)
Arthrocentesis, aspiration/injection, major joint or bursa; WITH ultrasound guidance, with permanent recording and reporting.
Free with practitioner sign-in — magic-link email auth, no credit card.
Rubrica tracks payor coverage for CPT 20611 (Major Joint Injection (with US)) across 98 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 20611
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna | Covered | Prior auth |
| Aetna Better Health of Florida | Covered | Prior auth |
| Aetna Better Health of Maryland | Covered | Prior auth |
| Aetna Better Health of New Jersey | Covered | Prior auth |
| Aetna Medicare Advantage | Covered | Prior auth |
| Alabama Medicaid | Covered | Prior auth |
| Alabama Medicaid (FFS) | Covered | Prior auth |
| Allstate Auto / PIP | Covered | Prior auth |
| AlohaCare | Covered | No PA |
| AmTrust Financial WC | Covered | Prior auth |
| AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices | Covered | Prior auth |
| Anthem BCBS | Covered | Prior auth |
Coverage themes for CPT 20611
Common patterns across the 98 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥4 weeks of conservative care before approving 20611.
6 of 98 payors require imaging concordance documentation.
Of the 98 payors with coverage records for CPT 20611, 10 require prior authorization, 66 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
See the policy for every payor.
Sign in to see verbatim coverage criteria, conservative-care duration requirements, imaging concordance rules, and the documentation each payor wants in the submission.
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