CPT code 17264 is used for the medical procedure involving the destruction of skin lesions.
CPT code 17264 is used to describe the medical procedure for the destruction of skin lesions. This code specifically refers to the treatment of skin growths or abnormalities using methods such as laser surgery, cryosurgery (freezing), electrosurgery (electric current), or other techniques to remove or destroy the lesions. This procedure is typically performed to treat benign, pre-malignant, or malignant skin conditions, ensuring that the abnormal tissue is effectively eradicated.
When billing for CPT code 17264, which pertains to 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 an unplanned procedure related to the initial one.
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 initial procedure and occurred during the postoperative period.
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 for a service that may not be covered.
12. Modifier GX: Notice of liability issued, voluntary under payer policy. Use this modifier if a voluntary ABN was issued for a service that is statutorily excluded or does not meet the definition of any Medicare benefit.
13. 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, ensuring accurate billing and reimbursement.
The CPT code 17264 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. To determine the specific reimbursement rate, you should refer to the Medicare Physician Fee Schedule (MPFS), which provides detailed information on the payment rates for various services covered by Medicare.
Additionally, the Medicare Administrative Contractor (MAC) for your region may have specific guidelines and local coverage determinations that could affect reimbursement. It is essential to consult both the MPFS and your regional MAC to get accurate and up-to-date information on the reimbursement for CPT code 17264.
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