CPT code 19295 is used for the procedure of placing a breast clip percutaneously, typically during a biopsy to mark the location for future reference.
CPT code 19295 is used for the procedure of placing a breast clip percutaneously. This involves inserting a small marker or clip into the breast tissue through the skin, typically guided by imaging techniques such as ultrasound or mammography. The clip serves as a reference point for future treatments or surgeries, helping healthcare providers accurately locate the area of interest within the breast.
For CPT code 19295, which involves the placement of a breast clip percutaneously, 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. For example, if a radiologist performs the procedure but the facility owns the equipment, the radiologist would use this modifier.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. For instance, if the facility provides the equipment and technical staff but not the professional interpretation, the facility would use this modifier.
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 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 can be used if the placement of the breast clip is performed in a different session or site than other procedures.
5. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left breast.
6. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right breast.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same physician repeats the procedure 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 if a different physician repeats the procedure 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 if the patient needs to return for an unplanned procedure related to the initial one during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the procedure is unrelated to the original procedure and is performed during the postoperative period of the initial procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19295, which involves placing a breast clip percutaneously, is reimbursed by Medicare. To determine the reimbursement specifics, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. Additionally, it's important to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they administer Medicare claims and can provide detailed information on coverage policies and any local variations in reimbursement.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 19295. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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