CPT code 21401 is a medical code for the closed treatment of an orbital fracture with manipulation.
CPT code 21401 is for the closed treatment of an orbital fracture, which involves manipulating the bones around the eye socket without making an incision. This procedure is typically done to realign the bones and ensure proper healing without the need for open surgery.
For CPT code 21401 (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. Documentation must support the substantial additional work and the reason for it.
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, and the service is unrelated to the recovery from the first 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 a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure is performed on both sides of the body during the same operative session.
5. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures are performed during the same operative session. This indicates that the procedure is one of several performed.
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 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 will perform the preoperative and/or postoperative management.
9. Modifier 55 - Postoperative Management Only
- Use this modifier if the physician performed the postoperative management only, and another provider performed the surgical procedure.
10. Modifier 56 - Preoperative Management Only
- Use this modifier if the physician performed the preoperative management only, and another provider performed the surgical procedure.
11. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
12. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the procedure was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
13. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier if the procedure was repeated by another physician or other qualified healthcare professional subsequent to the original procedure.
14. 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 returns to the operating room for a related procedure during the postoperative period of the initial procedure.
15. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
16. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
17. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required during the procedure.
18. 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.
19. Modifier 99 - Multiple Modifiers
- Use this modifier if multiple modifiers are necessary to describe the service provided.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for services rendered.
Medicare reimbursement for CPT code 21401, which pertains to the closed treatment of an orbital fracture with manipulation, depends on several factors including the setting of the service (e.g., hospital, outpatient clinic), the geographical location, and the specific Medicare Administrative Contractor (MAC) policies.
As of the latest available data, Medicare does reimburse for CPT code 21401. However, the exact reimbursement amount can vary. For instance, in a hospital outpatient setting, the reimbursement might differ from that in an ambulatory surgical center (ASC) or a physician's office. Additionally, the Medicare Physician Fee Schedule (MPFS) provides specific rates that can be referenced for the most accurate and up-to-date information.
To get a precise reimbursement amount, healthcare providers should consult the MPFS or contact their local MAC. These resources will provide the most current and applicable rates based on the specific circumstances of the service provided.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 21401 for closed treatment of orbital fractures with 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.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
