CPT code 19291 is for placing a needle wire in the breast, typically used for localization before a surgical biopsy or other breast procedures.
CPT code 19291 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 19291, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both breasts during the same session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Applied when the same procedure is repeated by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Used when a related procedure is performed during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician: Indicates that the procedure is unrelated to the original procedure and performed by the same physician during the postoperative period.
9. Modifier LT - Left Side: Specifies that the procedure was performed on the left breast.
10. Modifier RT - Right Side: Specifies that the procedure was performed on the right breast.
These modifiers help provide additional context and specificity to the procedure, ensuring accurate billing and reimbursement.
The CPT code 19291 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, healthcare providers should consult their specific MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 19291.
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