CPT code 21198 is a medical code used to describe the reconstruction of a lower jaw segment.
CPT code 21198 is for the reconstruction of a lower jaw segment. This procedure typically involves surgical techniques to rebuild or repair the lower jaw, often due to injury, disease, or congenital defects.
For CPT code 21198 (Reconstruction of lower jaw segment), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could apply if the reconstruction is more complex than usual.
2. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This might be relevant if only part of the lower jaw segment is reconstructed.
3. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient. This could apply if the reconstruction is started but not completed.
4. 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. This might be necessary if multiple procedures are performed on the same day.
5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure. This could be relevant if the reconstruction requires the expertise of two surgeons.
6. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure. This might be applicable for highly complex reconstructions involving multiple specialties.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician. This could apply if the reconstruction needs to be performed again due to complications or other reasons.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician. This might be relevant if the patient needs to undergo the reconstruction again with a different surgeon.
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 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: Used when an unrelated procedure 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 for the procedure. This might be necessary for complex reconstructions.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required because a qualified resident surgeon is not available.
14. Modifier 99 - Multiple Modifiers: Used when multiple modifiers are necessary to describe the circumstances of the procedure.
Each of these modifiers provides additional information about the circumstances under which CPT code 21198 is being billed, ensuring accurate and appropriate reimbursement for the services provided.
Medicare reimbursement for CPT code 21198, which pertains to the reconstruction of a lower jaw segment, depends on several factors, including medical necessity, the specific Medicare plan, and the setting in which the procedure is performed. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and is performed in an outpatient setting. However, the reimbursement amount can vary based on geographic location, the provider's fee schedule, and other considerations.
To determine the exact reimbursement amount for CPT code 21198, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or contact their local Medicare Administrative Contractor (MAC). These resources provide the most accurate and up-to-date information on reimbursement rates.
For a precise figure, it is advisable to use the MPFS Look-Up Tool available on the Centers for Medicare & Medicaid Services (CMS) website or consult with your billing department to ensure accurate and compliant billing practices.
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 21198 for lower jaw reconstruction. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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