CPT code 19084 is for an additional breast biopsy using ultrasound imaging.
CPT code 19084 is used for the biopsy of an additional breast lesion using ultrasound imaging. This code is specifically applied when a second or subsequent lesion in the breast is biopsied during the same session as the primary lesion, and ultrasound guidance is utilized to accurately locate and sample the tissue. This ensures that the additional lesion is properly evaluated for any abnormalities or conditions that may require further medical attention.
For CPT code 19084, which pertains to a biopsy of an additional breast lesion using ultrasound imaging, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, typically by the physician who interprets the ultrasound imaging.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed, typically by the facility that provides the ultrasound equipment and technician.
3. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both breasts during the same session.
4. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session, which may affect reimbursement rates.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the same procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the patient returns to the operating or procedure room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 99 - Multiple Modifiers: This modifier is used when multiple modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 19084, which involves a specific medical procedure, is subject to reimbursement by Medicare under certain conditions. To determine if CPT code 19084 is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and coverage policies for various CPT codes.
Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for specific guidelines and coverage determinations. MACs are responsible for interpreting national policies into local coverage decisions, which can vary by region. Therefore, while the MPFS offers a general framework, the final determination on reimbursement for CPT code 19084 will depend on the local MAC's policies and any specific criteria they may have established.
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