CPT code 20527 is for an injection to treat Dupuytren's contracture by breaking down the cord with an enzyme.
CPT code 20527 is for an injection procedure specifically targeting Dupuytren's contracture. This involves administering an enzyme directly into the fibrous cord in the hand that causes the fingers to contract, with the goal of breaking down the cord and improving finger movement.
For CPT code 20527 (Injection, enzyme (e.g., collagenase), palmar fascial cord (e.g., Dupuytren's contracture)), the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the injection is performed on both hands during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session. It indicates that the injection is one of several procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the injection is a distinct service from other procedures performed on the same day. It helps to avoid bundling issues.
4. Modifier RT - Right Side: This modifier is used to specify that the injection was performed on the right hand.
5. Modifier LT - Left Side: This modifier is used to specify that the injection was performed on the left hand.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the injection needs to be repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the injection needs to be repeated by a different physician on the same day.
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: This modifier is used if the patient needs to return for another injection related to the initial procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the injection is unrelated to the initial procedure and occurs during the postoperative period.
10. Modifier 99 - Multiple Modifiers: This modifier is used when more than four modifiers are necessary to describe the service.
These modifiers help provide additional information about the circumstances under which the injection was performed, ensuring accurate billing and reimbursement.
Medicare Reimbursement for CPT Code 20527: Injection, Dupuytren's Contracture with Enzyme
CPT code 20527 pertains to the injection of an enzyme to treat Dupuytren's contracture, a condition that affects the hand and fingers. Medicare does provide reimbursement for this procedure under certain conditions. The reimbursement amount can vary based on geographic location, the specific Medicare Administrative Contractor (MAC), and other factors such as the setting in which the procedure is performed (e.g., hospital outpatient department, physician's office).
As of the latest available data, the national average reimbursement rate for CPT code 20527 under Medicare Part B is approximately $300-$400. However, it is crucial to verify the exact reimbursement rate with your local MAC, as rates are subject to change and may vary.
For the most accurate and up-to-date information, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or contact their local MAC directly. Additionally, ensuring proper documentation and adherence to Medicare guidelines is essential for successful reimbursement.
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 20527 for Dupuytren's cord injection with enzyme. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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