CPT code 20612 is used for the procedure to aspirate or inject a ganglion cyst.
CPT code 20612 is used for the procedure where a healthcare provider aspirates (removes fluid from) or injects a ganglion cyst. This code specifically refers to the process of using a needle to either withdraw fluid from the cyst or inject medication into it to reduce swelling and discomfort.
When using CPT code 20612 for the aspiration and/or injection of a ganglion cyst, certain modifiers may be necessary to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 20612, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Used when the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service
- Indicates that the procedure is distinct or independent from other services performed on the same day.
4. Modifier RT - Right Side
- Specifies that the procedure was performed on the right side of the body.
5. Modifier LT - Left Side
- Specifies that the procedure was performed on the left side of the body.
6. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Indicates that the same procedure was 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
- Used when the patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Applied when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 22 - Increased Procedural Services
- Indicates that the work required to perform the procedure was substantially greater than typically required.
11. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Used when an unrelated evaluation and management service is performed by the same physician during the postoperative period.
12. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Indicates that a significant, separately identifiable evaluation and management service was provided by the same physician on the same day as the procedure.
13. Modifier 26 - Professional Component
- Used when only the professional component of the service is being billed.
14. Modifier TC - Technical Component
- Indicates that only the technical component of the service is being billed.
These modifiers help to provide a more complete picture of the services rendered and ensure accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
Medicare does reimburse for CPT code 20612, which pertains to the aspiration and/or injection of a ganglion cyst. The reimbursement amount can vary based on geographic location and specific Medicare Administrative Contractor (MAC) policies. As of the latest available data, the national average reimbursement for CPT code 20612 is approximately $100-$150. However, it is essential to verify the exact reimbursement rate with your local MAC, as rates are subject to change and may differ based on regional adjustments and other factors.
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 20612 for aspirate/inj ganglion cyst. Ensure you're receiving accurate reimbursements from every payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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