CPT code 11444 is for the excision of a benign lesion on the face, measuring 3.1 to 4 cm, including margins.
CPT code 11444 is used to describe the surgical procedure for the excision of a benign (non-cancerous) lesion on the face, including the margins, where the lesion measures between 3.1 to 4 centimeters in diameter. This code is specific to procedures that involve removing skin growths that are not malignant, ensuring that the surrounding tissue is also excised to achieve clear margins and reduce the risk of recurrence.
For CPT code 11444, 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 by the same provider.
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.
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 80: Assistant surgeon. Use this modifier if an assistant surgeon was required for the procedure.
10. Modifier 81: Minimum assistant surgeon. Use this modifier if a minimum assistant surgeon was required for the procedure.
11. Modifier 82: Assistant surgeon (when qualified resident surgeon not available). Use this modifier if an assistant surgeon was required and a qualified resident surgeon was not available.
12. Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery. Use this modifier if a non-physician provider assisted in the surgery.
13. Modifier LT: Left side. Use this modifier if the procedure was performed on the left side of the body.
14. Modifier RT: Right side. Use this modifier if the procedure was performed on the right side of the body.
15. Modifier XS: Separate structure. Use this modifier to indicate that a service was performed on a separate organ/structure.
16. Modifier XE: Separate encounter. Use this modifier to indicate that a service was performed during a separate encounter.
17. Modifier XP: Separate practitioner. Use this modifier to indicate that a service was performed by a different practitioner.
18. Modifier XU: Unusual non-overlapping service. Use this modifier to indicate that a service does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining whether CPT code 11444 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 11444 is reimbursed, you should first check the MPFS database, which is accessible through the Centers for Medicare & Medicaid Services (CMS) website. Enter the specific CPT code to see if it is listed and to review the associated reimbursement details.
Additionally, it's crucial to consult your regional MAC, as they are responsible for processing Medicare claims and can provide specific information regarding coverage policies and any local coverage determinations (LCDs) that might affect reimbursement for CPT code 11444. Each MAC may have unique guidelines or requirements that could influence whether this particular code is reimbursed in your area.
In summary, CPT code 11444 may be reimbursed by Medicare, but confirmation requires checking both the MPFS and the policies of your regional MAC.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. For instance, RevFind can identify discrepancies for specific codes like 11444, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your financial outcomes.
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