CPT code 11980 is used for the procedure of implanting hormone pellets under the skin to deliver consistent hormone levels over time.
CPT code 11980 is used for the procedure of implanting hormone pellets. This code is specifically designated for the insertion of small, solid pellets that release hormones over time, typically used in hormone replacement therapy. The procedure involves placing these pellets under the skin, usually in the hip or buttock area, to provide a steady release of hormones into the bloodstream. This method is often chosen for its convenience and long-lasting effects compared to other forms of hormone administration.
When using CPT code 11980 for the implantation of hormone pellet(s), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more effort or time than usual.
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 hormone pellet implantation and is distinct from the procedure.
3. Modifier 50 - Bilateral Procedure
- Use this modifier if the hormone pellet implantation was performed bilaterally.
4. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same session as the hormone pellet implantation.
5. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
6. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the hormone pellet implantation 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 hormone pellet implantation was repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the hormone pellet implantation was repeated by a different physician on the same day.
9. 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 to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician 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 hormone pellet implantation.
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 99 - Multiple Modifiers
- Use this modifier if more than one modifier is necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
The CPT code 11980, which involves the implantation of hormone pellets, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for any regional variations or specific guidelines that may apply to the reimbursement process for this CPT code.
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