CPT code 19318 is a medical code used to describe the surgical procedure for breast reduction.
CPT code 19318 is used to describe the surgical procedure for breast reduction. This code is utilized by healthcare providers to document and bill for the surgery where excess breast tissue, fat, and skin are removed to achieve a breast size in proportion with the body and to alleviate discomfort associated with overly large breasts.
For CPT code 19318 (Breast reduction), the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure
- Used when the procedure is performed on both breasts during the same operative session.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service
- Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
- Applied when the same procedure is repeated by the same physician.
5. Modifier 77 - Repeat Procedure by Another Physician
- Used when the same procedure is repeated by a different physician.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Applied when the patient returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when an unrelated procedure is performed by the same physician during the postoperative period.
8. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Applied when a non-physician provider assists in the surgery.
9. Modifier LT - Left Side
- Used to specify that the procedure was performed on the left breast.
10. Modifier RT - Right Side
- Used to specify that the procedure was performed on the right breast.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 19318 is reimbursed by Medicare, but it is subject to specific criteria and guidelines. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and ensuring that the services billed meet Medicare's coverage requirements. Therefore, it is essential for healthcare providers to verify that the documentation and medical necessity criteria are met according to the guidelines set forth by both the MPFS and the respective MAC.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 19318. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
