CPT code 15730 is for a muscle, myocutaneous, or fasciocutaneous flap with preservation of vascular pedicle.
CPT code 15730 is used to describe a medical procedure known as a "muscle, myocutaneous, or fasciocutaneous flap with preservation of vascular pedicle." This procedure involves the surgical movement of a flap of tissue, which includes muscle and skin, to a new location on the body while keeping the blood supply intact. This technique is often employed in reconstructive surgeries to repair defects or wounds, ensuring that the transferred tissue remains viable and healthy.
For CPT code 15730, 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. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 50 - Bilateral Procedure: Applied when the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is used to identify procedures that are not typically reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team: Applied when a team of surgeons (more than two) is required to perform a specific procedure.
8. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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: Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
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: Indicates that 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 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 15730, which refers to "Mdfc flap w/prsrv vasc pedcl," is subject to reimbursement by Medicare, but it depends on several factors. To determine if Medicare reimburses this specific CPT code, you need to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on whether CPT code 15730 is reimbursed. They may also have Local Coverage Determinations (LCDs) that outline specific criteria for reimbursement.
Therefore, to confirm if CPT code 15730 is reimbursed by Medicare, you should review the MPFS and consult with your regional MAC for any specific coverage guidelines or requirements.
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