CPT code 11442 is for excising a benign lesion on the face, measuring 1.1-2 cm, including margins.
CPT code 11442 is used to describe the excision of a benign (non-cancerous) lesion, including the margins, from the face, ears, eyelids, nose, lips, or mucous membrane. The size of the lesion being removed is between 1.1 to 2.0 centimeters. This code is specific to procedures where the lesion is excised with a margin of normal tissue around it to ensure complete removal.
Certainly! Here are the modifiers that could be used with the CPT code 11442:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Used when a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
3. Modifier 50 - Bilateral Procedure
- Used when the procedure is performed on both sides of the body.
4. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed at the same session by the same provider.
5. Modifier 52 - Reduced Services
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 59 - Distinct Procedural Service
- Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Used when a related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier 99 - Multiple Modifiers
- Used when two or more modifiers are necessary to describe the service.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement.
The CPT code 11442 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and pricing.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement rates and coverage policies for specific CPT codes within their jurisdictions. Therefore, while CPT code 11442 is generally reimbursed by Medicare, healthcare providers should consult the MPFS and their respective MAC for the most accurate and up-to-date information regarding reimbursement rates and coverage criteria.
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