CPT code 20900 is a medical code used to describe the removal of bone for grafting purposes.
CPT code 20900 is used to describe the procedure where a surgeon removes a piece of bone from one part of the patient's body to use it as a graft in another area. This is often done to help repair or rebuild bones that are damaged or missing.
When billing for CPT code 20900 (Removal of bone for graft), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 20900, 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 surgical 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 76 - Repeat Procedure by Same Physician
- Used when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
- Applied when the same procedure is repeated by a different physician on the same day.
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
- Used when the patient returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that the procedure is unrelated to the original procedure and is performed during the postoperative period.
8. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon
- Applied when a minimum assistant surgeon is required for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required because a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Indicates that a non-physician provider assisted in the surgery.
Each modifier serves a specific purpose and should be used accurately to reflect the circumstances of the procedure. Proper use of these modifiers can help ensure that claims are processed correctly and that reimbursement is appropriate.
Medicare does reimburse for CPT code 20900, which pertains to the removal of bone for graft. The reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and the setting in which the procedure is performed (e.g., hospital outpatient, inpatient, or ambulatory surgical center). As of the most recent data, the national average reimbursement rate for CPT code 20900 is approximately $200-$300. However, it is crucial to verify the exact reimbursement rate with the relevant MAC and consider any updates to the Medicare Physician Fee Schedule (MPFS) for the most accurate and current information.
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 20900 for the removal of bone for graft. 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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