CPT code 20664 is for the application of a halo, a device used to immobilize the head and neck for medical treatment.
CPT code 20664 is for the application of a halo, which is a device used to immobilize the head and neck. This procedure is typically done to stabilize the cervical spine after a serious injury or surgery. The halo consists of a ring that surrounds the head and is attached to the skull with pins, connected to a vest worn on the torso to keep the head and neck in a fixed position.
For CPT code 20664 (Application of halo), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to the complexity of the patient's condition or other factors that necessitate additional time and effort.
2. Modifier 52 (Reduced Services): Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This might occur if the full application of the halo was not necessary or if the procedure was stopped early due to unforeseen circumstances.
3. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the application of the halo was distinct or independent from other services performed on the same day. This is particularly relevant if multiple procedures are performed and need to be billed separately.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if the same physician needs to repeat the application of the halo within a short period due to complications or other medical reasons.
5. Modifier 77 (Repeat Procedure by Another Physician): Apply this modifier if a different physician repeats the application of the halo within a short period.
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): Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial halo application.
7. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial halo application.
8. Modifier 80 (Assistant Surgeon): Apply this modifier if an assistant surgeon was necessary for the application of the halo.
9. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if a minimum assistant surgeon was required for the procedure.
10. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used if an assistant surgeon was necessary because a qualified resident surgeon was not available.
11. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and appropriate reimbursement.
When considering the reimbursement of CPT code 20664 (Application of halo) by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the Local Coverage Determinations (LCDs) provided by Medicare Administrative Contractors (MACs).
As of the latest updates, CPT code 20664 is generally reimbursed by Medicare, but the reimbursement amount can vary based on geographic location and specific circumstances of the procedure. For instance, the national average reimbursement rate for CPT code 20664 may be around $1,200, but this figure can fluctuate.
To obtain the most accurate and current reimbursement rate, healthcare providers should refer to the MPFS on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC. Additionally, it is crucial to ensure that all documentation and medical necessity criteria are met to facilitate smooth reimbursement.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 20664 for the application of a halo. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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