CPT code 19286 is for the placement of a breast device with ultrasound imaging guidance.
CPT code 19286 is used to describe the procedure of placing a percutaneous device in the breast, with the addition of ultrasound imaging. This code is typically used when a healthcare provider needs to insert a device, such as a marker or clip, into the breast tissue to guide future treatments or surgeries, and they use ultrasound technology to ensure accurate placement.
For CPT code 19286, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the ultrasound imaging.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, such as the use of the ultrasound equipment and the technician's time.
3. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both breasts during the same session.
4. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure is repeated by a different physician on the same day.
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: Used if the patient needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if the procedure is unrelated to the original procedure and is performed during the postoperative period.
9. Modifier 99 - Multiple Modifiers: Used when more than four modifiers are necessary to describe the service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19286 is subject to reimbursement by Medicare, but its eligibility and the amount reimbursed are determined by the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided to Medicare beneficiaries. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing these guidelines at the regional level. Therefore, while CPT code 19286 may be reimbursed by Medicare, the specific reimbursement details can vary based on the MAC's local coverage determinations and policies. It is advisable for healthcare providers to consult the MPFS and their respective MAC for precise information on reimbursement for CPT code 19286.
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