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The answer to “can you bill cpt code 20610 twice” in a single encounter depends on whether the two procedures were performed on different joints: two different joints mean two separately reportable units of CPT 20610 with appropriate modifiers, while the same joint treated twice means one unit regardless of how many times the needle was inserted

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Duration at different dose levels At 1mg weekly (titration start): 20mg / 1mg per week = 20 weeks from a single vial You would never use the entire vial at this dose since titration advances every 4 weeks