CPT code 11952 is used for the treatment of contour defects involving the injection of 5.1 to 10 cubic centimeters of material.
CPT code 11952 is used for the treatment of contour defects involving the injection of a filler material in volumes ranging from 5.1 to 10 cubic centimeters (cc). This procedure is typically performed to correct irregularities or depressions in the skin, often resulting from trauma, surgery, or certain medical conditions. The code specifically indicates the amount of filler material used, ensuring accurate billing and documentation for the healthcare provider.
For CPT code 11952, which pertains to the treatment of contour defects with an injection volume of 5.1 to 10 cc, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure is performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same session. This helps indicate that the procedure is one of several performed.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when the same procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers
- This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11952, which involves the treatment of contour defects ranging from 5.1 to 10cc, is subject to reimbursement by Medicare. However, the reimbursement is contingent upon several factors, including the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for your region.
The MPFS provides a comprehensive list of fees that Medicare will pay for each service, and it is updated annually to reflect changes in medical practice and the cost of providing care. To determine if CPT code 11952 is reimbursed, you would need to consult the current MPFS. Additionally, each MAC may have specific local coverage determinations (LCDs) that could affect whether this code is reimbursed in your area. Therefore, it is crucial to verify with your regional MAC to ensure compliance with their specific requirements and guidelines.
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