CPT code 19301 is for a partial mastectomy, a surgical procedure to remove part of the breast tissue, often used in breast cancer treatment.
CPT code 19301 is used to describe a partial mastectomy, which is a surgical procedure where only a portion of the breast tissue is removed. This procedure is typically performed to excise a tumor or abnormal tissue while preserving as much of the breast as possible. It is often part of breast-conserving surgery aimed at treating breast cancer or other breast-related conditions.
When billing for CPT code 19301 (Partial mastectomy), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Used when the partial mastectomy is performed on both breasts during the same surgical session.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session, including the partial mastectomy.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Used if the partial mastectomy is part of a planned, staged procedure or if it is related to the initial surgery and performed during the postoperative period.
4. Modifier 59 - Distinct Procedural Service
- Indicates that the partial mastectomy is a distinct procedure from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when the same physician performs a repeat partial mastectomy procedure on the same patient.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Applied when a different physician performs a repeat partial mastectomy on the same patient.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Used if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial partial mastectomy.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that the partial mastectomy is unrelated to the original procedure performed by the same physician during the postoperative period.
9. Modifier LT - Left Side
- Used to specify that the partial mastectomy was performed on the left breast.
10. Modifier RT - Right Side
- Used to specify that the partial mastectomy was performed on the right breast.
11. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Applied when a resident performs the partial mastectomy under the supervision of a teaching physician.
These modifiers help provide additional information about the circumstances under which the partial mastectomy was performed, ensuring accurate billing and reimbursement.
The CPT code 19301 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 19301.
It is essential for healthcare providers to consult both the MPFS and their respective MACs to ensure compliance with Medicare's billing and reimbursement requirements for this code.
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 19301. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.
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