CPT CODES

CPT Code 01130

CPT code 01130 is used to identify anesthesia services provided during a body cast procedure for efficient healthcare documentation.

Table of Contents
What is CPT Code 01130
Does CPT 01130 Need a Modifier?
CPT Code 01130 Medicare Reimbursement
Are You Being Underpaid for 01130 CPT Code?
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What is CPT Code 01130

CPT code 01130 is used to describe the anesthesia services provided during a body cast procedure. This code is specifically designated for the administration of anesthesia to a patient who is undergoing the application or removal of a body cast. The use of this code ensures that the anesthesiologist or anesthesia provider is appropriately reimbursed for their role in managing the patient's pain and comfort during this particular procedure.

Does CPT 01130 Need a Modifier?

For CPT code 01130, which pertains to anesthesia services for body cast procedures, the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide the service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.

2. Modifier 23 - Unusual Anesthesia: This is used when a procedure that usually requires either no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.

3. Modifier 47 - Anesthesia by Surgeon: This modifier is applicable when the surgeon administers regional or general anesthesia to the patient. It is not used for local anesthesia.

4. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary to identify procedures/services that are not normally reported together but are appropriate under the circumstances.

5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when a procedure or service is repeated by the same provider subsequent to the original procedure or service.

6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when a procedure or service is repeated by a different provider subsequent to the original procedure or service.

7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This is used when a patient requires a return to the operating room for a related procedure during the postoperative period.

8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.

9. Modifier 99 - Multiple Modifiers: This is used when two or more modifiers are necessary to describe the service provided.

These modifiers help provide additional information about the circumstances under which the anesthesia service was provided, ensuring accurate billing and reimbursement. Proper documentation is crucial when applying these modifiers to support their use.

CPT Code 01130 Medicare Reimbursement

CPT code 01130, which pertains to an anesthesia service, is subject to reimbursement by Medicare, provided it meets specific criteria outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. Whether CPT code 01130 is reimbursed can also depend on the local coverage determinations made by the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and have the authority to establish coverage policies that may affect the reimbursement of certain CPT codes. Therefore, it is crucial for healthcare providers to verify the specific coverage and reimbursement details with their respective MAC to ensure compliance and proper billing practices.

Are You Being Underpaid for 01130 CPT Code?

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