CPT code 20986 is for a computer-assisted surgical procedure using imaging to guide the placement of a musculoskeletal prosthesis.
CPT code 20986 is used for the procedure of applying a computer-assisted device to direct musculoskeletal procedures using intraoperative imaging. This code is typically used when advanced imaging technology is employed during surgery to enhance precision and outcomes.
For CPT code 20986, which pertains to "Cptr-asst dir ms px io img," the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component only, such as the interpretation of the imaging.
2. Modifier TC - Technical Component: This modifier is used when the service provided is the technical component only, such as the use of the equipment and the technician's time.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used 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: This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
7. 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.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required and a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used 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.
Determining whether a specific CPT code, such as 20986 (Cptr-asst dir ms px io img), is reimbursed by Medicare involves several steps. Medicare reimbursement policies are governed by the Centers for Medicare & Medicaid Services (CMS), which periodically updates its coverage guidelines and fee schedules.
### Reimbursement Status of CPT Code 20986
1. Medicare Coverage Database (MCD):
- The first step is to check the Medicare Coverage Database (MCD) to see if there are any National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs) that apply to CPT code 20986. These determinations outline whether a service is covered and under what conditions.
2. Physician Fee Schedule (PFS):
- The Medicare Physician Fee Schedule (PFS) provides information on the reimbursement rates for specific CPT codes. You can search the PFS to find the allowable amount for CPT code 20986.
3. Local Medicare Administrative Contractors (MACs):
- Local MACs may have specific guidelines and fee schedules that apply to your geographic area. Checking with your local MAC can provide additional insights into whether CPT code 20986 is reimbursed and at what rate.
### Example Reimbursement Rate
As of the latest update, if CPT code 20986 is covered, the reimbursement rate can vary based on geographic location and other factors. For instance, the national average reimbursement rate might be around $150, but this can differ significantly.
### Steps to Verify Reimbursement
1. Access the Medicare Coverage Database (MCD):
- Visit the CMS website and navigate to the MCD to search for CPT code 20986.
2. Check the Physician Fee Schedule (PFS):
- Use the CMS PFS Look-Up Tool to find the specific reimbursement rate for CPT code 20986.
3. Consult Local MACs:
- Contact your local Medicare Administrative Contractor for region-specific information.
### Conclusion
To determine if CPT code 20986 is reimbursed by Medicare and to find the exact reimbursement amount, healthcare providers should utilize the Medicare Coverage Database, the Physician Fee Schedule, and consult with their local MACs. This multi-step approach ensures that you have the most accurate and up-to-date information regarding Medicare reimbursement for this specific CPT code.
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