CPT code 11954 is for the treatment of contour defects greater than 10.0 cc.
CPT code 11954 is used for the treatment of contour defects that are greater than 10.0 cubic centimeters. This code typically applies to procedures where a healthcare provider addresses and corrects irregularities or depressions in the skin or underlying tissue, often through the use of fillers or other medical techniques to restore a more natural and even appearance.
For CPT code 11954, which pertains to the treatment of contour defects greater than 10.0 cc, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. For instance, if the treatment of contour defects involves significantly more effort or time than usual, Modifier 22 can be appended.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both sides of the body, Modifier 50 should be used to indicate that the service was bilateral.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same session, Modifier 51 is used to indicate that more than one procedure was carried out.
4. Modifier 59 (Distinct Procedural Service): This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. For example, if the treatment of contour defects is performed in conjunction with another procedure that is not typically related, Modifier 59 can be used.
5. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure is repeated by the same physician, Modifier 76 should be appended to indicate that the procedure was performed more than once.
6. Modifier 77 (Repeat Procedure by Another Physician): If the procedure is repeated by a different physician, Modifier 77 is used to denote that the same service was performed by another 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): This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure, Modifier 79 should be used.
9. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, Modifier 80 is used to indicate the involvement of an assistant.
10. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): If an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon, Modifier 82 should be appended.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): This modifier is used when a non-physician provider assists 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 11954, which involves treatment of contour defects greater than 10.0 cc, is reimbursed by Medicare, provided it meets the criteria outlined in the Medicare Physician Fee Schedule (MPFS). To determine the specific reimbursement rate and any additional guidelines, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the relevant Medicare Administrative Contractor (MAC) for any local coverage determinations (LCDs) or specific billing requirements that may apply to this CPT code. Each MAC may have unique policies that could affect reimbursement, so checking with the appropriate MAC is crucial for accurate billing and compliance.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 11954. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can help you maximize your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
