CPT code 19290 is for placing a needle wire in the breast, typically used for localization before a surgical biopsy or lumpectomy.
CPT code 19290 is used to describe the procedure of placing a needle wire into the breast. This is typically done to mark a specific area within the breast tissue, often in preparation for a biopsy or surgical procedure. The needle wire helps guide the surgeon to the exact location that needs to be examined or removed.
For CPT code 19290, which involves the placement of a needle wire in the breast, 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 and report of the procedure, 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 equipment, supplies, and technical staff involved in the procedure.
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 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session. It indicates that more than one procedure was performed and helps in the appropriate allocation of reimbursement.
5. 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 helps in identifying procedures that are not typically reported together but are appropriate under the circumstances.
6. 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.
7. 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.
8. 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 needs to return to the operating room for a related procedure during the postoperative period.
9. 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.
10. 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 applicable to the procedure.
Each of these modifiers serves a specific purpose and helps in the accurate billing and reimbursement process for the services provided.
The CPT code 19290 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including their respective reimbursement rates. However, coverage and reimbursement can vary based on local policies set by the MAC, which administers Medicare claims for your region.
Therefore, it is advisable to consult both the MPFS and your MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 19290.
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