CPT code 11951 is used for the treatment of contour defects with an injection volume of 1.1 to 5.0 cubic centimeters.
CPT code 11951 is used to describe a medical procedure where a healthcare provider treats contour defects by injecting a substance in volumes ranging from 1.1 to 5.0 cubic centimeters (cc). This code is typically used in cases where there is a need to correct or enhance the shape of a particular area of the body, often for reconstructive or cosmetic purposes.
For CPT code 11951, which pertains to the treatment of contour defects with an injection volume of 1.1 to 5.0 cc, 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 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 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 performed.
9. Modifier 80: Assistant surgeon. Use this modifier if an assistant surgeon was necessary for the procedure.
10. Modifier 81: Minimum assistant surgeon. Use this modifier if a minimum assistant surgeon was required.
11. Modifier 82: Assistant surgeon (when qualified resident surgeon not available). Use this modifier if an assistant surgeon was required due to the unavailability of a qualified resident surgeon.
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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11951, which pertains to the treatment of contour defects ranging from 1.1 to 5.0 cc, is subject to reimbursement by Medicare. To determine if this specific CPT code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 11951.
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