CPT code 20972 is a medical code used to describe a procedure involving a bone or skin graft to the metatarsal.
CPT code 20972 is used for a procedure involving a bone or skin graft to the metatarsal, which is one of the long bones in the foot. This code is specifically for surgeries where a graft is needed to repair or reconstruct the metatarsal area.
When billing for CPT code 20972 (Bone/skin graft metatarsal), 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 20972, 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 the patient's condition.
2. Modifier 50 (Bilateral Procedure): If the bone/skin graft was performed on both metatarsals, this modifier should be appended to indicate a bilateral procedure.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that CPT code 20972 is one of several procedures.
4. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the bone/skin graft metatarsal procedure was distinct or independent from other services performed on the same day.
5. Modifier 76 (Repeat Procedure by Same Physician): If the same physician performs the bone/skin graft metatarsal procedure more than once on the same day, this modifier should be used.
6. Modifier 77 (Repeat Procedure by Another Physician): If a different physician performs the bone/skin graft metatarsal procedure on the same day, this modifier should be appended.
7. 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.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If the bone/skin graft metatarsal procedure is performed during the postoperative period of another unrelated procedure, this modifier should be used.
9. Modifier LT (Left Side): If the procedure was performed on the left metatarsal, this modifier should be appended to specify the location.
10. Modifier RT (Right Side): If the procedure was performed on the right metatarsal, this modifier should be appended to specify the location.
11. Modifier 62 (Two Surgeons): If two surgeons were required to perform the procedure, this modifier should be used to indicate the collaborative effort.
12. Modifier 66 (Surgical Team): If the procedure required a surgical team, this modifier should be used to indicate the involvement of multiple healthcare professionals.
By appropriately using these modifiers, healthcare providers can ensure accurate billing and reimbursement for CPT code 20972, while also maintaining compliance with payer guidelines.
Medicare reimbursement for CPT code 20972, which pertains to a bone or skin graft for the metatarsal, depends on several factors including the specific circumstances of the procedure, the patient's medical necessity, and the setting in which the service is provided. Generally, Medicare does cover bone and skin graft procedures when they are deemed medically necessary.
However, the exact reimbursement amount can vary based on the Medicare fee schedule, geographic location, and other factors. As of the latest available data, the national average reimbursement for CPT code 20972 is approximately $1,200, but this amount can fluctuate. Providers should consult the most recent Medicare Physician Fee Schedule (MPFS) or their local Medicare Administrative Contractor (MAC) for precise and up-to-date reimbursement rates.
For the most accurate information, healthcare providers are encouraged to verify coverage and reimbursement specifics directly with Medicare or through their billing department.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 20972 for bone/skin graft metatarsal. 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.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
