CPT code 12054 is for intermediate repair of the face, ears, eyelids, nose, or lips, measuring 7.6 to 12.5 cm.
CPT code 12054 is used to describe an intermediate repair of a wound on the face, ears, eyelids, nose, lips, or mucous membranes that measures between 7.6 to 12.5 centimeters. This type of repair involves layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia, in addition to the skin closure. It is more complex than a simple repair but does not involve the extensive work of a complex repair.
For CPT code 12054, which pertains to intermediate repair of the face, ears, eyelids, nose, lips, and/or mucous membranes for wounds measuring 7.6 to 12.5 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 by the same provider.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used for a planned or staged procedure during the postoperative period.
6. 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.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician.
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: Used for complications requiring a return to the operating room.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used for procedures or services unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 12054, which pertains to intermediate repair of the face, ears, eyelids, nose, or lips with a length of 7.6 to 12.5 cm, is reimbursed by Medicare.
Reimbursement for this code is determined based on the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, the specific reimbursement amount may vary depending on the region, as it is subject to adjustments by the Medicare Administrative Contractor (MAC) responsible for the geographic area where the service is provided.
It is advisable for healthcare providers to consult the MPFS and their respective MAC for the most accurate and up-to-date reimbursement information.
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