CPT code 11107 is for each additional or separate incisional biopsy of the skin, used for billing and documentation in healthcare.
CPT code 11107 is used to describe the procedure of performing an incisional biopsy of the skin for each separate or additional lesion. This means that if a healthcare provider needs to take a sample of skin tissue from more than one lesion for diagnostic purposes, they would use this code for each additional lesion beyond the first. This code ensures that the provider is accurately reimbursed for the extra work involved in examining multiple skin lesions.
For CPT code 11107, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used when an E/M service is provided on the same day as the procedure, and the E/M service is above and beyond the usual preoperative and postoperative care associated with the procedure.
2. 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.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used when a procedure or service is repeated by the same provider subsequent to the original procedure or service.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used when a procedure or service is repeated by a different provider subsequent to the original procedure or service.
5. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used when the service is provided through telemedicine.
7. Modifier XE: Separate encounter. This modifier is used to indicate that a service is distinct because it occurred during a separate encounter.
8. Modifier XS: Separate structure. This modifier is used to indicate that a service is distinct because it was performed on a separate organ/structure.
9. Modifier XP: Separate practitioner. This modifier is used to indicate that a service is distinct because it was performed by a different practitioner.
10. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that a service is distinct because it does not overlap usual components of the main service.
These modifiers help in providing additional information about the performed procedure and ensure accurate billing and reimbursement.
When determining if the CPT code 11107 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing Medicare policies at the regional level.
For CPT code 11107, you would need to verify its inclusion and reimbursement rate in the MPFS. If the code is listed in the MPFS, it is generally reimbursed by Medicare, subject to any specific guidelines or conditions outlined by the MACs in your region. Therefore, checking both the MPFS and the relevant MAC guidelines will provide a definitive answer regarding the reimbursement status of CPT code 11107.
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