CPT code 21120 is for the reconstruction of the chin, detailing the specific medical procedure for accurate billing and insurance purposes.
CPT code 21120 is for the surgical procedure involving the reconstruction of the chin. This code is used when a surgeon performs an operation to reshape or rebuild the chin, often to correct deformities, improve function, or enhance appearance.
For CPT code 21120 (Reconstruction of chin), 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 reconstruction of the chin required significantly more work than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure
- If the reconstruction procedure is performed bilaterally, this modifier should be appended to indicate that the procedure was done on both sides.
3. Modifier 51 - Multiple Procedures
- When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- Apply this modifier 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 reconstruction of the chin was a distinct procedural service from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- If the same physician needs to repeat the chin reconstruction procedure, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician
- If another physician needs to repeat the chin reconstruction procedure, this modifier should be used.
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
- Use this modifier if the patient needs 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 is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- If an assistant surgeon is required for the procedure, this modifier should be used.
11. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. 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 in the surgery.
14. Modifier LT - Left Side
- If the procedure is performed on the left side of the chin, this modifier should be used.
15. Modifier RT - Right Side
- If the procedure is performed on the right side of the chin, this modifier should be used.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and appropriate reimbursement.
Medicare reimbursement for CPT code 21120, which pertains to the reconstruction of the chin, depends on several factors including medical necessity, the setting in which the procedure is performed, and the specific Medicare Administrative Contractor (MAC) policies in your region.
Generally, Medicare does cover reconstructive surgeries if they are deemed medically necessary. For CPT code 21120, this would typically mean that the procedure is required to correct a functional impairment or to address a significant deformity resulting from trauma, disease, or congenital anomalies.
However, if the procedure is considered cosmetic, Medicare will not provide reimbursement. It is crucial to provide comprehensive documentation that supports the medical necessity of the procedure to ensure coverage.
The reimbursement amount can vary based on the geographic location and the specific Medicare fee schedule applicable to your practice. As of the latest available data, the national average reimbursement for CPT code 21120 under Medicare Part B is approximately $1,200. However, this amount can fluctuate, so it is advisable to consult the current Medicare Physician Fee Schedule or your local MAC for the most accurate and up-to-date reimbursement rates.
For precise information, healthcare providers should verify the coverage and reimbursement details with their local MAC and ensure that all necessary documentation is in place to support the claim.
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 21120 for chin reconstruction. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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