CPT code 21030 is a medical code used to describe the excision of a benign tumor from the maxilla or zygoma.
CPT code 21030 is used for the surgical procedure to excise (remove) a benign tumor from the maxilla (upper jaw) or zygoma (cheekbone). This code specifically refers to the removal of non-cancerous growths in these facial bones.
For CPT code 21030 (Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly greater effort than typically required. This could be due to factors such as the size or location of the tumor.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both sides of the maxilla or zygoma, this modifier should be used to indicate a bilateral procedure.
3. Modifier 51 (Multiple Procedures): If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that 21030 is one of several procedures.
4. Modifier 52 (Reduced Services): If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the service provided was less than usually required.
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. This is particularly relevant if the excision was performed in conjunction with other procedures that are not typically reported together.
6. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate that both surgeons are equally responsible for the procedure.
7. Modifier 76 (Repeat Procedure by Same Physician): If the same physician needs to repeat the procedure on the same day, this modifier should be used.
8. Modifier 77 (Repeat Procedure by Another Physician): If a different physician needs to repeat the procedure on the same day, this modifier should be used.
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): If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.
11. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required to help with the procedure, this modifier should be used.
12. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if a minimum assistant surgeon is required for the procedure.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): If an assistant surgeon is required because a qualified resident surgeon is not available, this modifier should be used.
14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): Use this modifier if a non-physician provider assists in the surgery.
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 21030, which pertains to the excision of a benign tumor from the maxilla or zygoma, depends on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., inpatient, outpatient, or ambulatory surgical center), and the patient's specific Medicare plan.
Generally, Medicare does reimburse for medically necessary surgical procedures, including the excision of benign tumors. However, the exact reimbursement amount can vary. As of the latest available data, the national average reimbursement rate for CPT code 21030 in an outpatient setting is approximately $1,200. This amount can fluctuate based on geographic location and other factors.
For the most accurate and up-to-date reimbursement information, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or contact their local MAC. Additionally, verifying coverage and obtaining prior authorization when necessary can help ensure that the procedure is reimbursed appropriately.
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 21030 for excising max/zygoma benign tumors. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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