CPT code 11950 is for the treatment of contour defects using 1 cc or less of injectable material.
CPT code 11950 is used for the injection of a filling material to correct contour defects in the skin, specifically when the volume of the material injected is 1 cubic centimeter (cc) or less. This procedure is often utilized in cases where there are depressions or irregularities in the skin that need to be smoothed out, such as scars or other skin imperfections.
For CPT code 11950, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used when an E/M service is provided on the same day as the procedure and is distinct from the procedure performed.
2. Modifier 50: Bilateral procedure. This modifier is used if the procedure is performed on both sides of the body.
3. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same session by the same provider.
4. Modifier 59: Distinct procedural service. This modifier is used to indicate that a procedure or service 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 healthcare professional. This modifier is used when the same procedure is repeated on the same day by the same provider.
6. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used when the same procedure is repeated on the same day by a different provider.
7. Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period.
8. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
9. Modifier LT: Left side. This modifier is used to indicate that the procedure was performed on the left side of the body.
10. Modifier RT: Right side. This modifier is used to indicate that the procedure was performed on the right side of the body.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11950, which involves treatment for contour defects using 1 cc or less, 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 essential 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 policies and any local variations in reimbursement.
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