CPT code 11402 is for the excision of a benign skin lesion, including margins, measuring 1.1 to 2 cm.
CPT code 11402 is used to describe the excision of a benign (non-cancerous) skin lesion, including the margins, with a diameter of 1.1 to 2 centimeters. This code is specifically for procedures where the lesion is removed from areas other than the face, ears, eyelids, nose, lips, or mucous membrane. The code ensures that the healthcare provider is accurately reimbursed for the complexity and extent of the procedure.
When using CPT code 11402, which pertains to the excision of a benign lesion including margins, measuring 1.1 to 2.0 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 50: Bilateral procedure. Use this modifier if the procedure was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
5. 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.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. Use this modifier if the same procedure was repeated on the same day by a different provider.
7. 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 had to return for a related procedure during the postoperative period.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if an unrelated procedure was performed during the postoperative period of the initial procedure.
9. Modifier LT: Left side. Use this modifier if the procedure was performed on the left side of the body.
10. Modifier RT: Right side. Use this modifier if the procedure was performed on the right side of the body.
11. Modifier GA: Waiver of liability statement issued as required by payer policy, individual case. Use this modifier if an Advance Beneficiary Notice (ABN) was issued for a service that might not be covered.
12. Modifier GX: Notice of liability issued, voluntary under payer policy. Use this modifier if a voluntary ABN was issued for a service that is not covered.
13. Modifier GZ: Item or service expected to be denied as not reasonable and necessary. Use this modifier if no ABN was issued and the service is expected to be denied.
14. Modifier Q6: Service furnished by a locum tenens physician. Use this modifier if the service was provided by a substitute physician.
These modifiers help provide additional information about the circumstances under which the procedure was performed and ensure accurate billing and reimbursement.
The CPT code 11402 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and these rates can vary based on geographic location and other factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement for CPT code 11402. MACs are responsible for processing Medicare claims and may have local coverage determinations (LCDs) that affect whether and how this code is reimbursed.
Therefore, it is essential to consult both the MPFS and the relevant MAC for precise reimbursement details for CPT code 11402.
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