CPT code 11960 is for the insertion of tissue expander(s), a procedure often used in reconstructive surgeries to stretch skin.
CPT code 11960 is used for the procedure of inserting tissue expander(s). This code is typically utilized in reconstructive surgeries, such as breast reconstruction following a mastectomy. The tissue expander is a balloon-like device that is gradually filled with saline to stretch the skin and create space for a future implant. This process helps prepare the area for a more permanent reconstruction.
For CPT code 11960 (Insert tissue expander(s)), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure
- Used when the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same surgical session.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Used when a subsequent procedure is planned or staged during the postoperative period of the initial procedure.
5. Modifier 59 - Distinct Procedural Service
- Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by another physician or other qualified health care professional.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- Used when a patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side (Used to identify procedures performed on the left side of the body)
- Used when the procedure is performed on the left side of the body.
11. Modifier RT - Right Side (Used to identify procedures performed on the right side of the body)
- Used when the procedure is performed on the right side of the body.
These modifiers help provide additional information about the procedure performed and ensure accurate billing and reimbursement.
CPT code 11960, which involves the insertion of tissue expander(s), is reimbursed by Medicare, but the specifics of reimbursement can vary. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including CPT code 11960. However, the final determination of reimbursement is often made by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and any potential local coverage determinations (LCDs) that may affect reimbursement for CPT code 11960. It is advisable to consult the MPFS and your regional MAC to confirm the exact reimbursement details for this code.
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