CPT code 0220T is for placing a posterior intrafacet implant in the thoracic spine, including imaging and bone graft or synthetic device placement.
CPT code 0220T is used to describe the procedure of placing a posterior intrafacet implant, which can be done on one side (unilateral) or both sides (bilateral) of the spine. This procedure includes the use of imaging techniques to guide the placement and may involve the insertion of bone grafts or synthetic devices. It is specifically applicable to a single level within the thoracic region of the spine. This code is typically used by healthcare providers to document and bill for this specific type of spinal surgery.
For CPT code 0220T, 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 the code description includes "unilateral or bilateral," this modifier would clarify that the procedure was performed bilaterally.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that 0220T 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 0220T is performed in conjunction with other procedures that might otherwise be considered part of a bundled service.
4. Modifier RT - Right Side: If the procedure is performed on the right side of the body, this modifier specifies the side.
5. Modifier LT - Left Side: If the procedure is performed on the left side of the body, this modifier specifies the side.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates that each surgeon is performing a distinct part of the procedure.
7. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier indicates that it is a repeat service.
8. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is used to indicate the repeat nature of the service.
These modifiers help provide additional information about the procedure, ensuring accurate billing and reimbursement. It's important to review the specific circumstances of each case to determine which modifiers are appropriate.
The CPT code 0220T, which involves the placement of a posterior intrafacet implant(s) at the thoracic level, is categorized as a Category III code. Category III codes are temporary codes for emerging technologies, services, and procedures. As such, they often require specific consideration for reimbursement.
Medicare reimbursement for CPT code 0220T is not guaranteed and can vary. The Medicare Physician Fee Schedule (MPFS) does not typically assign a national payment rate for Category III codes, including 0220T, because these codes are often considered experimental or investigational. Therefore, reimbursement decisions are often left to the discretion of the local Medicare Administrative Contractors (MACs).
MACs are responsible for processing Medicare claims and have the authority to determine coverage and payment for services not explicitly covered by the MPFS. Providers should consult their local MAC to determine if CPT code 0220T is reimbursed in their region and under what circumstances. Additionally, providers may need to submit supporting documentation to justify the medical necessity of the procedure to secure reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 0220T, and 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
