CPT code 20250 is for an open bone biopsy, a procedure where a sample of bone tissue is taken through an incision for diagnostic purposes.
CPT code 20250 is used for an open bone biopsy. This means that a surgeon makes an incision to access and remove a small sample of bone tissue for examination. This procedure helps diagnose conditions affecting the bone, such as infections, cancers, or other bone disorders.
For CPT code 20250 (Open bone biopsy), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
8. 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 when a related procedure is performed during the postoperative period of the initial procedure.
9. 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.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when a non-physician provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When determining if a specific CPT code, such as 20250 (Open bone biopsy), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs). As of the latest updates, CPT code 20250 is generally reimbursed by Medicare, provided that the procedure is deemed medically necessary and meets all coverage criteria.
The reimbursement amount for CPT code 20250 can vary based on geographic location and other factors. For a precise reimbursement rate, healthcare providers should refer to the MPFS for their specific region. As an example, the national average reimbursement rate for CPT code 20250 is approximately $300, but this figure can fluctuate.
To ensure accurate billing and reimbursement, it is advisable to verify the current rates and coverage policies through the Centers for Medicare & Medicaid Services (CMS) website or consult with a Medicare Administrative Contractor (MAC).
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 20250 for open bone biopsy. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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