CPT code 11975 is used for billing the insertion of a contraceptive cap, a procedure to place a barrier method of birth control.
CPT code 11975 is used to describe the medical procedure for inserting a contraceptive cap. This code is utilized by healthcare providers to document and bill for the service of placing a contraceptive cap, which is a barrier method of birth control designed to prevent pregnancy.
For CPT code 11975, "Insert contraceptive cap," the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more effort or time than typically required.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Apply this modifier if an evaluation and management (E/M) service was performed on the same day as the insertion of the contraceptive cap and is distinct from the procedure.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same session. This indicates that the insertion of the contraceptive cap was one of several procedures.
4. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the insertion of the contraceptive cap was a distinct procedural service from other services performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the procedure was repeated by the same physician or healthcare professional.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the procedure was repeated by a different physician or healthcare professional.
9. 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
- Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist 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 11975, which is for the insertion of a contraceptive cap, 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's important to consult with your regional Medicare Administrative Contractor (MAC) for any specific guidelines or variations in reimbursement policies that may apply to your locality. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment for CPT code 11975.
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