CPT code 19297 is for placing a catheter in the breast for radiation therapy.
CPT code 19297 is used to describe the procedure of placing a catheter into the breast for the purpose of delivering radiation therapy. This code is typically used in the context of breast cancer treatment, where precise delivery of radiation is crucial for targeting cancerous tissues while minimizing exposure to surrounding healthy tissues. The catheter serves as a conduit through which radioactive materials can be administered directly to the affected area.
For CPT code 19297, which pertains to the placement of a breast catheter for radiation, 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 their expertise and interpretation, 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 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. 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 on the same day.
5. Modifier 52 - Reduced Services: This modifier is used when the service provided is less than the usual service described by the CPT code. It indicates that the procedure was partially reduced or eliminated at the physician's discretion.
6. Modifier 53 - Discontinued Procedure: This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
7. 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. It is used to avoid bundling issues.
8. 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.
9. 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.
10. 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 a patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
11. 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.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19297, which involves the placement of a breast catheter for radiation, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various CPT codes, including 19297. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC) as they administer Medicare claims and can provide region-specific information regarding coverage and reimbursement policies for this CPT code.
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