CPT code 20604 is a procedure for draining or injecting a joint or bursa using ultrasound guidance.
CPT code 20604 is used for the procedure of draining or injecting a joint or bursa with the guidance of ultrasound. This code specifically indicates that the healthcare provider used ultrasound imaging to accurately guide the needle into the joint or bursa for the purpose of either removing fluid or administering medication.
For CPT code 20604 (Drain/inj joint/bursa w/us), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the procedure.
2. Modifier 50: Bilateral procedure. Use this modifier if the procedure was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
5. Modifier RT: Right side. Use this modifier to specify that the procedure was performed on the right side of the body.
6. Modifier LT: Left side. Use this modifier to specify that the procedure was performed on the left side of the body.
7. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. Use this modifier if the procedure was repeated on the same day by the same provider.
8. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. Use this modifier if the procedure was repeated on the same day by a different provider.
9. Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient had to return for a related procedure during the postoperative period.
10. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. Use this modifier if the procedure was unrelated to the original procedure performed during the postoperative period.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 20604, which refers to the drainage or injection of a joint or bursa with ultrasound guidance, is generally reimbursed by Medicare. However, the reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and the setting in which the service is provided (e.g., hospital outpatient department, physician's office).
As of the latest available data, the national average reimbursement rate for CPT code 20604 under the Medicare Physician Fee Schedule (MPFS) is approximately $100 to $150. It's important to verify the exact reimbursement rate with your local MAC and consider any updates to the MPFS that may affect the rate.
For the most accurate and up-to-date information, healthcare providers should consult the Medicare Fee Schedule Lookup Tool or contact their local MAC directly.
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 20604 for joint or bursa drainage with ultrasound. 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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