CPT code 19281 is used for the placement of a percutaneous device in the breast for the first imaging procedure.
CPT code 19281 is used to describe the placement of a percutaneous device for breast localization, which is guided by imaging. This code specifically applies to the first lesion that is being targeted. This procedure is typically performed to mark the exact location of a breast abnormality before a biopsy or surgery, ensuring precision in treatment.
For CPT code 19281, which pertains to the percutaneous placement of a breast localization device, 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. It indicates that the provider is billing for the interpretation of the imaging, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of the equipment and the technician's services, not the interpretation.
3. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both breasts during the same session. It indicates that the service was provided bilaterally.
4. Modifier 52 - Reduced Services: This modifier is used when the service provided is less extensive than described in the CPT code. It indicates that the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: This modifier is used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not normally reported together but are appropriate under the circumstances.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 99 - Multiple Modifiers: This modifier is used when two or more 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 19281 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 19281. Additionally, MACs may have specific guidelines or requirements that could impact reimbursement.
Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 19281.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 19281, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
