CPT code 21400 is for a closed treatment of an orbital fracture without manipulation.
CPT code 21400 is for the closed treatment of an orbital fracture without manipulation. This means that a healthcare provider treats a fracture around the eye socket without needing to physically adjust or move the bones back into place.
For CPT code 21400 (Closed treatment of orbital fracture without manipulation), the following modifiers may be applicable depending on the specific circumstances of the treatment:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Use this modifier if an evaluation and management service was performed during the postoperative period of another procedure, but is unrelated to the original procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier if an evaluation and management service was provided on the same day as the procedure but is distinct and separately identifiable from the procedure.
4. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure was performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures were performed during the same session.
6. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
7. 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.
8. Modifier 54 - Surgical Care Only: Use this modifier if the physician performed the surgical care only and another provider is responsible for preoperative and postoperative care.
9. Modifier 55 - Postoperative Management Only: Use this modifier if the physician is responsible only for the postoperative management of the patient.
10. Modifier 56 - Preoperative Management Only: Use this modifier if the physician is responsible only for the preoperative management of the patient.
11. Modifier 57 - Decision for Surgery: Use this modifier if an evaluation and management service resulted in the initial decision to perform the surgery.
12. Modifier 59 - Distinct Procedural Service: Use this modifier if a procedure or service was distinct or independent from other services performed on the same day.
13. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the same procedure was repeated by the same physician.
14. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure was repeated by a different physician.
15. 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 had to return to the operating room for a related procedure during the postoperative period.
16. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of another procedure.
17. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required during the procedure.
18. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required during the procedure.
19. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
20. Modifier 99 - Multiple Modifiers: Use this modifier if multiple modifiers are applicable to the procedure.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Always verify the necessity and appropriateness of each modifier based on the specific clinical scenario and payer guidelines.
Medicare reimbursement for CPT code 21400, which refers to "Closed treatment of orbital fracture without manipulation," depends on several factors, including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the service is provided, and whether the service is deemed medically necessary.
As of the latest available data, Medicare does reimburse for CPT code 21400, but the reimbursement amount can vary. For instance, in a non-facility setting, the national average reimbursement rate might be around $200-$300. However, this amount can differ based on geographic location and other factors.
To obtain the most accurate and up-to-date reimbursement rate for CPT code 21400, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or contact their local MAC. Additionally, verifying the specific coverage policies and any potential documentation requirements is crucial to ensure proper reimbursement.
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 21400 for closed treatment of orbit without manipulation. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.
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