CPT code 21012 is a medical code used to describe the excision of a lesion on the face that is less than 2 cm in size.
CPT code 21012 is used for a surgical procedure that involves excising (removing) a lesion from the face, specifically when the lesion is subcutaneous (located just under the skin) and measures 2 centimeters or less in size.
For CPT code 21012 (Excision of facial lesion, subcutaneous, less than 2 cm), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to factors such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Used when a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
3. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
4. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
5. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician subsequent to the original procedure or service.
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: Used when a patient requires a 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: Used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare Reimbursement for CPT Code 21012
CPT code 21012, which refers to the excision of a lesion from the face, subcutaneous tissue, up to 2 cm, is generally reimbursed by Medicare. However, the reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and the facility where the procedure is performed.
As of the most recent data, the national average reimbursement for CPT code 21012 is approximately $200-$300. To obtain the exact reimbursement rate, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or contact their local MAC for the most accurate and up-to-date information.
It's important to note that Medicare reimbursement is contingent upon the procedure being deemed medically necessary and properly documented. Providers should ensure that all relevant documentation and coding guidelines are meticulously followed to facilitate smooth reimbursement processes.
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 21012. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action.
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