CPT code 21480 is for the procedure to reset a dislocated jaw.
CPT code 21480 is used for the medical procedure of resetting a dislocated jaw. This involves a healthcare professional manually or surgically repositioning the jaw back into its proper alignment after it has been dislocated.
For CPT code 21480 (Reset dislocated jaw), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort 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 the initial procedure, but is unrelated to the initial 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 was provided on the same day as 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 provided only the surgical care and not the preoperative or postoperative management.
9. Modifier 55 - Postoperative Management Only: Use this modifier if the physician provided only the postoperative care.
10. Modifier 56 - Preoperative Management Only: Use this modifier if the physician provided only the preoperative care.
11. Modifier 57 - Decision for Surgery: Use this modifier if the 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 procedure was repeated by the same physician.
14. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the 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.
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 AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare typically reimburses for CPT code 21480, which is used for the procedure to reset a dislocated jaw. However, the reimbursement amount can vary based on several factors, including the geographic location of the provider, the setting in which the service is provided (e.g., hospital outpatient, inpatient, or physician's office), and whether the provider is participating in Medicare.
As of the most recent data, the national average reimbursement rate for CPT code 21480 under the Medicare Physician Fee Schedule (MPFS) is approximately $500. It's important to verify the exact reimbursement rate through the Medicare Administrative Contractor (MAC) for your specific region, as rates can fluctuate and are subject to annual updates.
Providers should also ensure that the procedure is medically necessary and properly documented to meet Medicare's coverage criteria, as this can impact reimbursement eligibility.
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 21480 for resetting a dislocated jaw. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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