CPT code 19285 is for the placement of a breast localization device using ultrasound guidance for the first lesion.
CPT code 19285 is used to describe the procedure of placing a localization device in the breast using ultrasound guidance. This code specifically applies to the first lesion that is being targeted. This procedure is typically performed to mark the exact location of an abnormality within the breast tissue, which can then be used to guide further diagnostic or therapeutic interventions, such as a biopsy or surgery.
For CPT code 19285, which pertains to a percutaneous device placement in the breast under 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. It indicates that the provider is billing for the interpretation of the ultrasound 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 performance of the ultrasound imaging, 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 than what is usually required. It indicates that the procedure was partially reduced or eliminated at the discretion of the provider.
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 the procedure is distinct or independent from other services performed on the same day. It is used to avoid bundling issues and to show that the procedures are not related.
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. It indicates that the procedure was necessary to be performed again.
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. It indicates that the procedure was necessary to be performed again by another provider.
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 the patient returns to the operating room for a related procedure 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. It indicates that multiple modifiers are being used to provide a complete description of the service.
These modifiers help to provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining whether CPT code 19285 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and their corresponding reimbursement rates under Medicare Part B.
To ascertain if CPT code 19285 is reimbursed, you would first need to check the MPFS to see if the code is listed and if it has an assigned reimbursement rate. If the code is present in the MPFS, it indicates that Medicare recognizes and reimburses for this service.
Additionally, it's crucial to review the Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) provided by your MAC. These documents offer detailed information on coverage criteria, including any specific conditions or limitations that apply to the reimbursement of CPT code 19285.
In summary, to determine if CPT code 19285 is reimbursed by Medicare, you should:
1. Check the Medicare Physician Fee Schedule (MPFS) for the code and its reimbursement rate.
2. Review the Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) from your Medicare Administrative Contractor (MAC) for any specific coverage guidelines.
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