CPT code 19296 is for the placement of a catheter in the breast for radiation therapy.
CPT code 19296 is used for the placement of a catheter into the breast for the purpose of delivering radiation therapy. This procedure is typically part of a treatment plan for breast cancer, where precise delivery of radiation is crucial for targeting cancerous cells while minimizing exposure to surrounding healthy tissue.
When using CPT code 19296 for the placement of a breast catheter for radiation therapy, 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 instance, if the physician is only providing the interpretation and report, this modifier would be appropriate.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. This would apply if the facility is billing for the use of equipment, supplies, and technical staff.
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 when the service provided is less than usually required. For example, if the procedure was partially completed due to patient complications.
5. Modifier 53 - Discontinued Procedure: This modifier is used when the procedure is 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 a procedure or service was distinct or independent from other services performed on the same day. This could apply if multiple procedures are performed that are not typically reported together.
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 19296, which involves the placement of a catheter, is reimbursed by Medicare under specific conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 19296.
Additionally, it is essential to consult with the local Medicare Administrative Contractor (MAC) for specific coverage policies and any regional variations in reimbursement. MACs are responsible for processing Medicare claims and can provide authoritative guidance on whether CPT code 19296 is covered and under what circumstances. By checking both the MPFS and the local MAC guidelines, healthcare providers can ensure accurate billing and reimbursement for this procedure.
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