CPT code 21011 is for excising a lesion on the face, less than 2 cm.
CPT code 21011 is for a surgical procedure involving the excision (removal) of a lesion (abnormal tissue) from the face, where the lesion is less than 2 centimeters in size.
When using CPT code 21011 for excision of a facial lesion with a size less than 2 cm, the following modifiers may be applicable:
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 face.
3. Modifier 51 (Multiple Procedures): Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 52 (Reduced Services): This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 (Repeat Procedure by Same Physician): Apply this modifier if the same procedure was repeated by the same physician.
7. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier if the procedure was repeated by a different physician.
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 if the patient had 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): Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
10. Modifier 80 (Assistant Surgeon): Use this modifier if an assistant surgeon was required during the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Apply this modifier if a minimum assistant surgeon was required.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. 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.
These modifiers help provide additional information about the circumstances of the procedure, ensuring 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 21011, which refers to the excision of a lesion from the face with a size less than 2 cm, depends on several factors including the medical necessity of the procedure, the setting in which it is performed, and the specific Medicare Administrative Contractor (MAC) policies in your region.
As of the latest available data, Medicare does reimburse for CPT code 21011 when the procedure is deemed medically necessary. The reimbursement amount can vary based on geographic location and other factors. On average, the Medicare Physician Fee Schedule (MPFS) lists the national payment amount for CPT code 21011 at approximately $200-$300. However, this amount can fluctuate, so it is essential to verify the current rates through the MPFS Look-Up Tool or consult your local MAC for the most accurate and up-to-date information.
For precise reimbursement details, healthcare providers should always refer to the latest Medicare guidelines and fee schedules.
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 21011 for excision of facial lesions smaller than 2 cm. 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
