CPT code 15365 is for applying a cultured dermal substitute to the face, neck, hands, or feet.
CPT code 15365 is used for the application of a cultured dermal substitute to the face, neck, hands, feet, or genitalia. This procedure involves placing a lab-grown skin substitute onto these specific areas to aid in wound healing or skin regeneration.
For CPT code 15365, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services)
- Use this modifier if the procedure required significantly more effort than typically required. This could be due to complications or other factors that increased the complexity of the procedure.
2. Modifier 50 (Bilateral Procedure)
- Apply this modifier if the procedure was performed on both sides of the body during the same session.
3. Modifier 51 (Multiple Procedures)
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that the procedure is one of several performed.
4. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period)
- This modifier is used if the procedure was planned or anticipated (staged) or if it was more extensive than the original procedure.
5. Modifier 59 (Distinct Procedural Service)
- Apply 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 Same Physician or Other Qualified Health Care Professional)
- Use this modifier if the same procedure was repeated by the same provider.
7. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional)
- This modifier is used when the same 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)
- Apply this modifier if the patient had to return to the operating room unexpectedly for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period)
- Use this modifier if the procedure performed is unrelated to the original procedure during the postoperative period.
10. Modifier 80 (Assistant Surgeon)
- This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon)
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available))
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery)
- This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers provides additional information that can affect billing and reimbursement, ensuring that the specifics of the procedure are accurately communicated to payers.
The CPT code 15365, "Apply cult derm sub f/n/hf/g," is subject to reimbursement by Medicare, but it is essential to verify its status on the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates. Additionally, the specific reimbursement and coverage details for CPT code 15365 can vary depending on the local policies set by the Medicare Administrative Contractor (MAC) for your region. Therefore, it is advisable to consult the MPFS and your regional MAC to confirm the reimbursement status and any specific billing requirements for CPT code 15365.
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