CPT code 20934 is for the surgical procedure involving the placement of an intercalary allograft to repair or replace bone defects.
CPT code 20934 is used for a surgical procedure involving the placement of an intercalary allograft. This means that a segment of donor bone is implanted to replace a missing section of bone within the patient's body, typically to address bone loss due to trauma, disease, or surgery. The term "intercalary" refers to the graft being placed between two existing bone segments to bridge a gap.
For CPT code 20934 (Intercalary allograft, complete), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty of the case.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be appended to indicate that the service was bilateral.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the service provided was less than usually required.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier should be used to indicate that each surgeon is performing a distinct part of the procedure.
7. Modifier 66 - Surgical Team: When a complex procedure requires the services of a surgical team, this modifier should be used to indicate that multiple providers are involved in the surgery.
8. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier should be used to indicate the repeat service.
9. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure on the same day, this modifier should be used to indicate the repeat service by another provider.
10. Modifier 78 - Unplanned Return to the Operating Room: If the patient requires an unplanned return to the operating room for a related procedure during the postoperative period, this modifier should be used.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure, this modifier should be used.
12. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used to indicate the involvement of an assistant.
13. Modifier 81 - Minimum Assistant Surgeon: If a minimum assistant surgeon is required, this modifier should be used to indicate the limited involvement of an assistant.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
When determining if a specific CPT code, such as 20934 (Intercalary allograft, complete), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) for the most accurate and up-to-date information.
As of the latest available data, CPT code 20934 is generally reimbursed by Medicare, but the reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC) overseeing the region, and any applicable modifiers.
To find the exact reimbursement amount for CPT code 20934, healthcare providers should:
1. Access the Medicare Physician Fee Schedule (MPFS): This can be done through the Centers for Medicare & Medicaid Services (CMS) website or through specialized software that provides updated fee schedules.
2. Check Local Coverage Determinations (LCDs): These documents provide guidance on whether a particular service is covered and under what circumstances. LCDs can vary by region and MAC.
3. Use the CMS Fee Lookup Tool: This tool allows providers to enter the CPT code and their specific location to get an estimated reimbursement amount.
For example, as of the latest update, the national average reimbursement for CPT code 20934 might be approximately $1,200, but this figure can fluctuate based on the aforementioned factors.
Providers should always verify the most current information through official CMS resources or their billing department to ensure accurate billing and 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 20934 for intercalary allograft complications. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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