CPT code 21440 is used to bill for the treatment of a dental ridge fracture.
CPT code 21440 is used for the treatment of a dental ridge fracture. This code is specifically for procedures that involve the repair or stabilization of fractures in the bony ridge that supports the teeth.
When billing for CPT code 21440 (Treat dental ridge fracture), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 21440, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services)
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period)
- Apply this modifier if an unrelated evaluation and management service is performed by the same physician during the postoperative period of the dental ridge fracture treatment.
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 provided on the same day as the dental ridge fracture treatment.
4. Modifier 50 (Bilateral Procedure)
- Apply this modifier if the dental ridge fracture treatment is performed bilaterally.
5. Modifier 51 (Multiple Procedures)
- Use this modifier if multiple procedures, including the dental ridge fracture treatment, are performed during the same surgical session.
6. Modifier 52 (Reduced Services)
- Apply 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 threatened the well-being of the patient.
8. Modifier 59 (Distinct Procedural Service)
- Apply this modifier to indicate that the dental ridge fracture treatment was distinct or independent from other services performed on the same day.
9. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional)
- Use this modifier if the same procedure is repeated by the same physician or other qualified healthcare professional.
10. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional)
- Apply this modifier if the same procedure is repeated by a different physician or other qualified healthcare professional.
11. 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 requires an unplanned return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period)
- Apply this modifier if an unrelated procedure or service is performed by the same physician during the postoperative period.
13. Modifier 80 (Assistant Surgeon)
- Use this modifier if an assistant surgeon is required during the dental ridge fracture treatment.
14. Modifier 81 (Minimum Assistant Surgeon)
- Apply this modifier if a minimum assistant surgeon is required during the procedure.
15. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available))
- Use this modifier if an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
16. Modifier 99 (Multiple Modifiers)
- Apply this modifier if multiple modifiers are necessary to accurately describe the circumstances of the procedure.
Proper use of these modifiers ensures that the billing for CPT code 21440 is accurate and reflects the specific circumstances of the treatment provided. Always verify payer-specific guidelines as they may have unique requirements or restrictions regarding modifier usage.
Medicare typically does not cover dental procedures, including those related to the treatment of dental ridge fractures, as outlined by CPT code 21440. This is because Medicare Part A and Part B generally exclude routine dental care and procedures. However, there may be exceptions if the dental procedure is deemed medically necessary as part of a covered service, such as preparation for certain surgeries or treatments.
For specific reimbursement rates, it is essential to consult the Medicare Physician Fee Schedule (MPFS) or contact your Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information. As of the latest updates, there is no standard reimbursement amount listed for CPT code 21440 under Medicare, reinforcing the general exclusion of dental services from coverage.
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 21440 for treating dental ridge fractures. 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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