CPT code 19200 is for the surgical removal of breast tissue, typically performed to treat or prevent breast cancer.
CPT code 19200 is used to describe the surgical procedure for the removal of a breast. This code is typically utilized in medical billing to indicate that a mastectomy, which is the complete removal of breast tissue, has been performed. This procedure is often necessary for patients diagnosed with breast cancer or other serious breast conditions. The use of this specific CPT code ensures accurate documentation and billing for the healthcare services provided.
For CPT code 19200, "Removal of breast," the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both breasts during the same operative session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side: Indicates that the procedure was performed on the left breast.
5. Modifier RT - Right Side: Indicates that the procedure was performed on the right breast.
6. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
7. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Indicates that a non-physician provider assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 19200 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, the reimbursement may be subject to local coverage determinations (LCDs) made by the Medicare Administrative Contractor (MAC) for the provider's region. These MACs have the authority to establish specific guidelines and payment policies that can affect the reimbursement process.
Therefore, it is essential for providers to consult both the MPFS and their respective MAC to ensure accurate billing and reimbursement for CPT code 19200.
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