CPT code 20702 is for the manual preparation and insertion of an implantable medication device.
CPT code 20702 is for the manual preparation and insertion of an implantable medication device. This code is used when a healthcare provider manually prepares and inserts a device that will deliver medication directly to a specific area of the body.
For CPT code 20702 (Manual preparation and insertion of drug delivery device, intramuscular), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier if a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
3. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both sides of the body.
4. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures are performed during the same session.
5. Modifier 52 - Reduced Services: Use this modifier if the procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated by a different physician.
9. 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 returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier if a PA, NP, or CNS assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 20702, which refers to the manual preparation and insertion of an implantable medication device, is reimbursed by Medicare under certain conditions. The reimbursement amount can vary based on factors such as 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 20702 under the Medicare Physician Fee Schedule (MPFS) is approximately $200. However, it is crucial to verify the exact reimbursement rate with the relevant MAC and consider any applicable adjustments or modifiers that may affect the final payment amount.
Healthcare providers should also ensure that the service meets all Medicare coverage criteria and documentation requirements to avoid claim denials or delays in 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 20702 for manual preparation and insertion of an implantable medication device. Ensure you're receiving accurate reimbursements from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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