CPT code 01490 is used for anesthesia services during procedures involving casting on the lower leg.
CPT code 01490 is used to describe the anesthesia services provided for procedures involving the casting of the lower leg. This code is specifically utilized when a patient requires anesthesia to manage pain and ensure comfort during the application or removal of a cast on the lower leg. It is important for healthcare providers to use this code accurately to ensure proper billing and reimbursement for the anesthesia services associated with such orthopedic procedures.
When dealing with CPT code 01490, which pertains to anesthesia for procedures on the lower leg, below the knee, there are several modifiers that may be applicable. These modifiers are used to provide additional information about the service provided and can affect reimbursement. Here is a list of potential modifiers that could be used with CPT code 01490:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a 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 applicable when a procedure that usually requires no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.
3. Modifier 47 - Anesthesia by Surgeon: Used when the surgeon administers regional or general anesthesia to the patient. This is not typically applicable to anesthesia codes but may be relevant in specific scenarios.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician: This is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, but used when the repeat procedure is performed by a different physician or qualified healthcare professional.
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 returns to the operating room for a related procedure during the postoperative period of the initial procedure.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
9. Modifier AA - Anesthesia Services Performed Personally by Anesthesiologist: Indicates that the anesthesiologist personally performed the anesthesia service.
10. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: Used when an anesthesiologist is directing multiple anesthesia procedures.
11. Modifier QS - Monitored Anesthesia Care Service: Indicates that monitored anesthesia care was provided.
12. Modifier QX - CRNA Service with Medical Direction by a Physician: Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
13. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist: Indicates that an anesthesiologist is directing one CRNA.
14. Modifier QZ - CRNA Service without Medical Direction by a Physician: Used when a CRNA provides anesthesia services without the medical direction of a physician.
These modifiers help clarify the circumstances under which the anesthesia service was provided and ensure accurate billing and reimbursement. It is crucial to use the appropriate modifiers to reflect the specific details of the service rendered.
CPT code 01490 is associated with anesthesia services for procedures involving the lower leg. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. CPT code 01490, like other anesthesia codes, is typically included in the MPFS, but reimbursement rates can vary based on geographic location and other factors.
Additionally, each MAC, which is responsible for processing Medicare claims in different regions, may have specific local coverage determinations (LCDs) that affect the reimbursement of certain CPT codes. Therefore, it is crucial to verify with your local MAC to ensure that CPT code 01490 is covered and to understand any specific billing requirements or documentation needed for reimbursement.
In summary, while CPT code 01490 is generally reimbursable under Medicare, it is essential to consult the MPFS and your regional MAC for precise details regarding coverage and reimbursement rates.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 01490, RevFind provides detailed insights by individual payer. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
