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Reference: OIG.HHS.gov

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It is not an area to be treated by non-physician practitioners such as physician assistants or nurses due to the risk of severe complications, when not injected properly

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