CPT code 20957 is a medical billing code for a microvascular bone graft procedure.
CPT code 20957 is for a procedure involving a microvascular bone graft. This means that a surgeon takes a piece of bone from one part of the patient's body and transplants it to another area, using microsurgical techniques to connect the blood vessels, ensuring the grafted bone has a blood supply to help it heal and integrate properly.
For CPT code 20957 (Mt bone graft microvasc), 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 procedure required significantly greater effort or complexity than typically required.
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 59 - Distinct Procedural Service
- This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. It indicates that the procedure was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
6. Modifier 66 - Surgical Team
- Use this modifier when a team of surgeons is required to perform the procedure due to its complexity.
7. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same physician repeats the procedure on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician repeats the procedure on the same day.
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 needs to return 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
- This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when an assistant surgeon is required for a minimal portion of the procedure.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Always refer to the latest CPT guidelines and payer-specific policies for the most accurate and up-to-date information.
Medicare reimbursement for CPT code 20957, which pertains to a microvascular bone graft, is subject to specific criteria and guidelines. Generally, Medicare does reimburse for this procedure, but the amount can vary based on several factors, including geographic location, the setting in which the procedure is performed (inpatient vs. outpatient), and the specific Medicare Administrative Contractor (MAC) policies.
As of the latest available data, the national average reimbursement rate for CPT code 20957 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,200 to $1,500. However, this amount can fluctuate, and it is essential to verify the current rates through the Centers for Medicare & Medicaid Services (CMS) or your local MAC.
For the most accurate and up-to-date information, healthcare providers should consult the Medicare Fee Schedule Lookup Tool or contact their MAC directly. Additionally, ensuring that all documentation and medical necessity criteria are met is crucial for successful reimbursement.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving full reimbursement for procedures like CPT code 20957, Mt bone graft microvasc. Schedule a demo today to see how RevFind can optimize your revenue cycle and protect your bottom line.
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