CPT code 17106 is for the destruction of skin lesions using laser surgery, including any necessary local anesthesia.
CPT code 17106 is used to describe the procedure for the destruction of skin lesions. This code specifically pertains to the treatment of benign (non-cancerous) skin growths or lesions using methods such as laser surgery, electrosurgery, cryosurgery, or other techniques. The goal of this procedure is to remove or destroy the unwanted skin tissue, often for medical or cosmetic reasons.
When using CPT code 17106 for the destruction of skin lesions, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the procedure.
2. Modifier 50: Bilateral procedure. Use this modifier if the procedure was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
5. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the procedure was repeated on the same day.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. Use this modifier if the procedure was repeated on the same day by a different provider.
7. Modifier 78: Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient had to return for a related procedure.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the procedure was unrelated to the original procedure performed.
9. Modifier LT: Left side. Use this modifier to indicate that the procedure was performed on the left side of the body.
10. Modifier RT: Right side. Use this modifier to indicate that the procedure was performed on the right side of the body.
11. Modifier GA: Waiver of liability statement issued as required by payer policy, individual case. Use this modifier if an Advance Beneficiary Notice (ABN) was issued to the patient.
12. Modifier GX: Notice of liability issued, voluntary under payer policy. Use this modifier if a voluntary ABN was issued.
13. Modifier GY: Item or service statutorily excluded, does not meet the definition of any Medicare benefit. Use this modifier if the service is not covered by Medicare.
14. Modifier GZ: Item or service expected to be denied as not reasonable and necessary. Use this modifier if no ABN was issued and the service is expected to be denied.
These modifiers help provide additional information about the circumstances under which the procedure was performed and ensure accurate billing and reimbursement.
When determining if CPT code 17106 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various healthcare services, including procedures represented by CPT codes.
To verify reimbursement for CPT code 17106, you should:
1. Check the MPFS: Access the MPFS database to see if CPT code 17106 is listed and review the associated reimbursement rates and any specific coverage criteria.
2. Consult Your MAC: Each MAC may have additional local coverage determinations (LCDs) that affect whether and how CPT code 17106 is reimbursed. These determinations can provide more detailed information on the medical necessity and documentation requirements for reimbursement.
By following these steps, healthcare providers can ascertain whether CPT code 17106 is reimbursed by Medicare and ensure compliance with both national and local Medicare policies.
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