CPT CODES

CPT Code 20933

CPT code 20933 is a medical code used to describe a partial hemicortical intercalary allograft procedure.

Table of Contents
What is CPT Code 20933
Does CPT 20933 Need a Modifier?
CPT Code 20933 Medicare Reimbursement
Are You Being Underpaid for 20933 CPT Code?
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What is CPT Code 20933

CPT code 20933 is used for a procedure involving the insertion of a partial intercalary allograft in the hemicortical region. This means that a surgeon is placing a donor bone graft into a specific part of the bone to replace a missing or damaged section, typically to help with bone healing or reconstruction.

Does CPT 20933 Need a Modifier?

When using CPT code 20933 for "Hemicortical intercalary allograft partial," it is essential to consider the appropriate modifiers to ensure accurate billing and reimbursement. Below is a list of potential modifiers that could be used with CPT code 20933, along with the reasons for their use:

1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased complexity or time.

2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same operative session.

3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.

4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.

5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.

6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.

7. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the 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
- This modifier is used when the patient needs to return 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
- Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

10. Modifier LT - Left Side
- Apply this modifier to indicate that the procedure was performed on the left side of the body.

11. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right side of the body.

12. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure.

13. Modifier 66 - Surgical Team
- Apply this modifier when a team of surgeons is required to perform the procedure due to its complexity.

14. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the procedure.

15. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.

16. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.

By correctly applying these modifiers, healthcare providers can ensure accurate coding, billing, and reimbursement for the services rendered.

CPT Code 20933 Medicare Reimbursement

Determining whether a specific CPT code, such as 20933 (Hemicrt intrclry algrft prtl), is reimbursed by Medicare involves several steps. Medicare reimbursement is contingent on various factors including medical necessity, the setting in which the service is provided, and whether the service is covered under Medicare's guidelines.

For CPT code 20933, Medicare does provide reimbursement, but the amount can vary based on geographic location, the specific Medicare Administrative Contractor (MAC), and the setting (e.g., inpatient vs. outpatient). As of the latest available data, the national average reimbursement rate for CPT code 20933 is approximately $1,200. However, this figure can fluctuate, and it is advisable to consult the Medicare Physician Fee Schedule (MPFS) or your local MAC for the most accurate and up-to-date reimbursement information.

Additionally, it is crucial to ensure that all documentation supports the medical necessity of the procedure to avoid claim denials. Providers should also verify patient eligibility and any specific coverage criteria that may apply to this code under Medicare guidelines.

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