CPT code 11981 is for the insertion of a drug delivery implant, used to administer medication directly into the body.
CPT code 11981 is used for the insertion of a drug delivery implant. This code is specifically utilized when a healthcare provider places an implantable device under the skin that is designed to release medication over a period of time. This procedure is often performed to ensure a consistent and controlled delivery of medication, which can be crucial for managing certain medical conditions.
For CPT code 11981 (Insertion, non-biodegradable drug delivery implant), the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified health care professional on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the insertion procedure.
2. Modifier 50: Bilateral procedure. Use this modifier if the procedure was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same session.
4. Modifier 52: Reduced services. Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59: Distinct procedural service. Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the same procedure was repeated on the same day.
7. Modifier 77: Repeat procedure by another physician or other qualified health care professional. Use this modifier if the same procedure was repeated on the same day by a different provider.
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. Use this modifier if the patient had to return to the operating room for a related procedure.
9. Modifier 79: Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period. Use this modifier if an unrelated procedure was performed during the postoperative period of the initial procedure.
10. Modifier 80: Assistant surgeon. Use this modifier if an assistant surgeon was required for the procedure.
11. Modifier 81: Minimum assistant surgeon. Use this modifier if an assistant surgeon was required for a minimal part of the procedure.
12. Modifier 82: Assistant surgeon (when qualified resident surgeon not available). Use this modifier if an assistant surgeon was required because a qualified resident was not available.
13. Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery. Use this modifier if a non-physician provider assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 11981, which pertains to the insertion of a drug delivery implant, 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 your region, as they can provide detailed information on coverage policies and any potential local variations in reimbursement.
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