CPT code 15274 is for skin substitute grafts applied to a child's trunk, arms, or legs, covering additional areas beyond the initial graft.
CPT code 15274 is used to describe the procedure of applying a skin substitute graft to a child's trunk, arms, or legs. This code specifically refers to an additional 100 square centimeters or part thereof, beyond the initial 100 square centimeters covered by a different primary code. This means that if a larger area needs treatment, this code is used to account for the extra work and materials required.
Certainly! Here are the modifiers that could be used with CPT code 15274:
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 a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
3. Modifier 50 - Bilateral Procedure
- Used when the procedure is performed on both sides of the body.
4. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed at the same session by the same provider.
5. Modifier 52 - Reduced Services
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
6. 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.
7. 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.
8. 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 physician or other qualified healthcare professional.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
10. 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 when a related procedure is performed during the postoperative period of the initial procedure.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
14. 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.
15. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- Used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent test results.
These modifiers help provide additional information about the performed procedure and ensure accurate billing and reimbursement.
The CPT code 15274, which involves skin substitute grafts, is reimbursed by Medicare, but the specifics of reimbursement can vary. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing Medicare policies at the regional level. They may have specific guidelines and coverage determinations that affect whether and how CPT code 15274 is reimbursed.
Therefore, it is essential to consult the MPFS and the relevant MAC for the most accurate and up-to-date information regarding reimbursement for this CPT code.
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