CPT code 0219T is for placing a posterior intrafacet implant in the cervical spine, including imaging and bone graft or synthetic device placement.
CPT code 0219T is used to describe the procedure of placing a posterior intrafacet implant, either on one side (unilateral) or both sides (bilateral), at a single level in the cervical spine. This code includes the use of imaging techniques to guide the placement and may also involve the insertion of bone grafts or synthetic devices to support the implant. This procedure is typically performed to stabilize the spine and alleviate pain or other symptoms associated with spinal conditions.
For CPT code 0219T, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body. Since 0219T can be unilateral or bilateral, this modifier indicates that the procedure was performed bilaterally.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that 0219T is one of several procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be necessary if 0219T is performed in conjunction with other procedures that are not typically reported together.
4. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right side of the body when the procedure is unilateral.
5. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left side of the body when the procedure is unilateral.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates that each surgeon performed a distinct part of the procedure.
7. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the expertise of a surgical team, indicating that 0219T was performed with multiple specialists.
8. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier is used to indicate the repetition.
9. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure on the same day, this modifier is used.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the procedure is performed during the postoperative period of another procedure but is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific policies to ensure appropriate use of modifiers.
The CPT code 0219T, which involves the placement of a posterior intrafacet implant, is categorized as a Category III code. Category III codes are typically temporary codes used for emerging technologies, services, and procedures. As such, they often do not have established reimbursement rates under the Medicare Physician Fee Schedule (MPFS).
Medicare reimbursement for CPT code 0219T is not guaranteed and can vary. It is essential to consult with your local Medicare Administrative Contractor (MAC) to determine if this specific code is reimbursed in your region. MACs have the authority to make coverage decisions for services not explicitly covered under the MPFS, and they may have specific guidelines or requirements for reimbursement of Category III codes like 0219T.
Healthcare providers should verify with their MAC and review any local coverage determinations (LCDs) or national coverage determinations (NCDs) that might apply to ensure compliance and understand the potential for reimbursement.
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 specific codes like 0219T, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
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
