CPT code 21263 is a medical code used to describe the surgical procedure for revising eye sockets.
CPT code 21263 is for a surgical procedure that involves revising or reconstructing the eye sockets. This can include reshaping the bone structure around the eyes to correct deformities or to improve the fit of prosthetic eyes.
For CPT code 21263 (Revise eye sockets), 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 perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both eye sockets during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician.
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 when a related procedure is performed during the postoperative period of the initial procedure.
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.
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 and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT and payer guidelines to confirm the appropriate use of modifiers.
Medicare reimbursement for CPT code 21263, which pertains to the revision of eye sockets, is contingent upon 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 Part B may cover this procedure if it is deemed medically necessary and is performed in an outpatient setting.
To determine the exact reimbursement amount, you would need to refer to the Medicare Physician Fee Schedule (MPFS) or contact your local MAC. The reimbursement rates can vary based on geographic location and other factors. As of the latest available data, the national average reimbursement for CPT code 21263 is approximately $1,200, but this figure can fluctuate.
For the most accurate and up-to-date information, it is advisable to consult the MPFS or your local MAC directly.
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