CPT code 21084 is used for the preparation of a face or oral prosthesis, detailing the specific medical procedure involved.
CPT code 21084 is used for the preparation of a face or oral prosthesis. This involves the detailed work required to create a custom prosthetic device for a patient's face or mouth, which can include taking impressions, designing the prosthesis, and ensuring it fits properly to restore function and appearance.
When billing for CPT code 21084 (Prepare face/oral prosthesis), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to prepare the face/oral prosthesis is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This indicates that the service provided was less than what is typically required for CPT code 21084.
3. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient. This indicates that the procedure was not completed as planned.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician needs to repeat the procedure on the same day. This indicates that the procedure was performed more than once by the same provider.
6. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician needs to repeat the procedure on the same day. This indicates that the procedure was performed more than once by different providers.
7. 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 needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon is required to help with the procedure. This indicates that another surgeon assisted in the preparation of the face/oral prosthesis.
10. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure. This indicates that the assistance provided was minimal.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon is required because a qualified resident surgeon was not available.
12. 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 for the services provided. Proper documentation is essential to support the use of any modifier.
Medicare reimbursement for CPT code 21084, which pertains to the preparation of a face/oral prosthesis, can vary based on several factors including the specific Medicare plan, the geographic location, and the medical necessity as determined by Medicare guidelines. Generally, Medicare Part B may cover prosthetic devices if they are deemed medically necessary and prescribed by a physician. However, it is crucial to verify the specific coverage details and reimbursement rates through the Medicare Administrative Contractor (MAC) for your region.
As of the latest available data, the reimbursement amount for CPT code 21084 is not universally fixed and can differ. Providers should consult the Medicare Physician Fee Schedule (MPFS) or their local MAC for the most accurate and up-to-date reimbursement rates. Additionally, it is advisable to ensure that all documentation and coding are precise to facilitate the reimbursement process.
For the most accurate and current information, healthcare providers should regularly check the CMS website or contact their local MAC.
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 21084 for preparing face/oral prostheses. 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.
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