CPT code 11306 is for the procedure of shaving a skin lesion that measures between 0.6 and 1.0 cm.
CPT code 11306 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 surface of the skin, rather than excising it completely or using other methods. This procedure is typically performed to remove benign or potentially problematic skin growths for diagnostic or therapeutic reasons.
For CPT code 11306, 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 the procedure 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 was 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 by a different provider on the same day.
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. This modifier is used if the patient needs to return for a related procedure.
6. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the procedure is unrelated to the original procedure.
7. Modifier LT: Left side. This modifier is used to specify that the procedure was performed on the left side of the body.
8. Modifier RT: Right side. This modifier is used to specify that the procedure was performed on the right side of the body.
9. Modifier 50: Bilateral procedure. This modifier is used if the procedure was performed on both sides of the body.
10. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same session.
11. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. This modifier is used if the procedure was planned or anticipated.
12. Modifier 22: Increased procedural services. This modifier is used if the work required to perform the procedure is substantially greater than typically required.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 11306, which involves the shaving of a skin lesion measuring 0.6-1.0 cm, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, it is important to consult with the specific Medicare Administrative Contractor (MAC) for your region, as they are responsible for processing Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 11306.
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