CPT code 19325 is a medical billing code used to describe the procedure for breast augmentation with implants.
CPT code 19325 is used to describe the surgical procedure for breast augmentation with implants. This code is specifically assigned to the operation where a surgeon places breast implants to enhance the size and shape of a patient's breasts. This procedure can be performed for cosmetic reasons or as part of reconstructive surgery following mastectomy or other breast-related surgeries.
For CPT code 19325 (Breast augmentation with implant), 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: Used 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 80 - Assistant Surgeon: Applied when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied when an assistant surgeon is required, and a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these healthcare professionals assist in the surgery.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 19325 for breast augmentation with implant is generally not reimbursed by Medicare. According to the Medicare Physician Fee Schedule (MPFS), this procedure is typically considered cosmetic and not medically necessary, which means it falls outside the scope of covered services.
However, there may be exceptions if the procedure is deemed medically necessary due to specific conditions such as post-mastectomy reconstruction. In such cases, the determination of coverage would be made by the Medicare Administrative Contractor (MAC) for your region.
It is essential to consult the local MAC guidelines and submit the necessary documentation to support the medical necessity of the procedure.
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