CPT code 15135 is for a dermal autograft procedure on the face, neck, hands, or feet, involving the transplantation of skin from one area to another.
CPT code 15135 is used to describe a procedure where a healthcare provider takes a piece of skin from one part of a patient's body (known as an autograft) and transplants it to the face, neck, hands, or feet. This code specifically applies to skin grafts in these sensitive and visible areas, often performed to repair damage from injuries, burns, or surgeries.
For CPT code 15135, which pertains to dermal autografts for the face, neck, hands, or feet, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used if the procedure was planned or anticipated (staged).
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 the procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when the procedure 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 complications or other unplanned returns to the operating room.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when the procedure is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for 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 a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these professionals assist in the surgery.
14. Modifier LT - Left Side: Used to specify that the procedure was performed on the left side of the body.
15. Modifier RT - Right Side: Used to specify that the procedure was performed on the right side of the body.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement.
The CPT code 15135 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding payment rates. To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and providing guidance on Medicare coverage policies. Each MAC may have specific local coverage determinations (LCDs) that could affect the reimbursement of CPT code 15135. Therefore, it is advisable for healthcare providers to check with their respective MAC to ensure compliance with any local policies and to obtain accurate reimbursement information.
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