CPT code 19287 is a medical billing code for the first percutaneous breast biopsy with MRI guidance.
CPT code 19287 is used to describe the procedure of placing a percutaneous device in the breast under MRI guidance for the first lesion. This code is typically utilized when a healthcare provider needs to insert a device, such as a marker or localization wire, into the breast tissue to aid in the diagnosis or treatment of a breast condition, and the procedure is performed with the assistance of magnetic resonance imaging (MRI) to ensure precise placement.
For CPT code 19287, which pertains to a percutaneous device placement in the breast under MRI guidance, 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 radiologist who interprets the MRI.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed, typically by the facility providing the MRI equipment and support.
3. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both breasts during the same session.
4. Modifier 52 - Reduced Services: This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: This modifier is used if the procedure was 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.
7. 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.
8. 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.
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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
10. 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.
11. 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 19287, "Perq dev breast 1st mr guide," is subject to reimbursement by Medicare, but its eligibility and the amount reimbursed are determined by several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. To determine if CPT code 19287 is reimbursed, healthcare providers should consult the MPFS for the specific year in question.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on whether CPT code 19287 is covered and the conditions under which it is reimbursed. Providers should check with their local MAC to ensure compliance with any regional policies or additional documentation requirements that may affect reimbursement for this specific CPT code.
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