CPT code 21073 is a medical billing code for the manipulation of the temporomandibular joint (TMJ) with anesthesia.
CPT code 21073 is for a manipulation of the temporomandibular joint (TMJ) performed under anesthesia. This procedure involves adjusting the TMJ, which connects the jaw to the skull, to improve its function or alleviate pain, and it is done while the patient is under anesthesia to ensure comfort and precision.
When billing for CPT code 21073 (Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring anesthesia), it is important 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 21073, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 47 - Anesthesia by Surgeon
- Use this modifier if the surgeon administers the anesthesia during the procedure.
3. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure is performed on both temporomandibular joints.
4. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures are performed during the same surgical session.
5. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
6. 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.
7. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure is repeated by a different physician on the same day.
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 requires an unplanned 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
- Use this modifier if the procedure is unrelated to the original procedure and is performed during the postoperative period.
11. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon is required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assists during the surgery.
Proper use of these modifiers can help ensure that claims are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 21073, which refers to the manipulation of the temporomandibular joint (TMJ) under anesthesia, is indeed reimbursed by Medicare. However, the reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and the setting in which the procedure is performed (e.g., hospital outpatient department, ambulatory surgical center, or physician's office).
As of the most recent data, the national average reimbursement rate for CPT code 21073 under the Medicare Physician Fee Schedule (MPFS) is approximately $300. This amount can fluctuate, so it is essential to verify the current rate through the Medicare Fee Schedule Lookup Tool or consult your local MAC for the most accurate and up-to-date information.
Additionally, it is important to ensure that all necessary documentation and medical necessity criteria are met to facilitate smooth reimbursement. Always check for any specific local coverage determinations (LCDs) or national coverage determinations (NCDs) that may apply to this procedure.
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 21073 for manipulation of the temporomandibular joint with anesthesia. 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
