CPT code 11440 is for the excision of a benign lesion on the face, measuring 0.5 cm or less, including margins.
CPT code 11440 is used to describe the excision of a benign (non-cancerous) lesion, including the margins, from the face, ears, eyelids, nose, or lips, where the lesion is 0.5 centimeters or smaller in diameter. This code is specific to procedures that involve removing these small benign growths from sensitive areas of the face and head, ensuring that the surrounding tissue is also excised to achieve clear margins.
For CPT code 11440, which involves excision of benign lesions on the face with margins of 0.5 cm or less, 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 surgical 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 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 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 to the operating room 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 the procedure was unrelated to the original procedure and occurred during the postoperative period.
9. Modifier LT: Left side. Use this modifier to indicate that the procedure was performed on the left side of the body.
10. Modifier RT: Right side. Use this modifier to indicate that 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 to the patient.
12. Modifier GX: Notice of liability issued, voluntary under payer policy. Use this modifier if a voluntary ABN was issued to the patient.
13. Modifier GY: Item or service statutorily excluded, does not meet the definition of any Medicare benefit. Use this modifier if the service is excluded from Medicare coverage.
14. 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11440 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 11440. However, the actual reimbursement may also depend on the specific Medicare Administrative Contractor (MAC) that processes claims in your region. Each MAC may have different local coverage determinations (LCDs) and policies that can influence the reimbursement process. Therefore, it is essential to consult the MPFS and your regional MAC for precise information on the reimbursement for CPT code 11440.
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