CPT code 11301 is for the procedure of shaving a skin lesion that measures between 0.6 and 1.0 cm in diameter.
CPT code 11301 is used to describe the procedure of shaving a skin lesion that measures between 0.6 and 1.0 centimeters in diameter. This code is specifically for instances where a healthcare provider removes a lesion by shaving it off the skin, rather than excising it completely. This method is often used for lesions that are raised above the skin surface and can be removed without cutting into the deeper layers of the skin.
For CPT code 11301, which pertains to the shaving of a skin lesion measuring 0.6-1.0 cm, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to 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.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the same procedure is repeated on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when the same procedure is repeated on the same day by a different provider.
5. Modifier 78: Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
6. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. Use this modifier if the procedure was planned or staged at the time of the original procedure.
8. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed at the same session by the same provider.
9. Modifier 22: Increased procedural services. Use this modifier if the work required to provide the service is substantially greater than typically required.
10. Modifier 24: Unrelated evaluation and management service by the same physician during a postoperative period. This modifier is used when an E/M service provided during the postoperative period is unrelated to the original procedure.
These modifiers help to provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11301, which involves a specific medical procedure, is reimbursed by Medicare. Reimbursement for this code is determined based on the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, the reimbursement may be subject to local coverage determinations (LCDs) set by the Medicare Administrative Contractor (MAC) for your specific region. It is essential to verify with your MAC to ensure compliance with any regional policies or additional documentation requirements that may affect reimbursement for CPT code 11301.
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