CPT code 12006 is for the repair of superficial wounds on the scalp, neck, arms, or trunk, measuring 20.1 to 30.0 cm in length.
CPT code 12006 is used for the repair of superficial wounds on the scalp, neck, arms, or trunk that are between 20.1 to 30.0 centimeters in length. This code specifically applies to the closure of these wounds using simple suturing techniques.
For CPT code 12006, which pertains to the repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk, and/or extremities (excluding hands and feet) with a length of 20.1 to 30.0 cm, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater 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: Used when an E/M service is performed on the same day as the procedure.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used when a procedure or service during the postoperative period was planned or anticipated.
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 provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by a different provider.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used for unplanned returns to the operating room for related procedures.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same provider during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used according to the clinical scenario and payer guidelines to ensure accurate billing and reimbursement.
The CPT code 12006 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and these rates can vary based on geographic location and other factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement for CPT code 12006. MACs are responsible for processing Medicare claims and may have local coverage determinations (LCDs) that affect whether and how this code is reimbursed.
Therefore, it is essential to consult the MPFS and the relevant MAC guidelines to understand the exact reimbursement details for CPT code 12006.
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