CPT code 21494 is used for the surgical treatment of a hyoid bone fracture.
CPT code 21494 is used for the surgical treatment of a fractured hyoid bone. The hyoid bone is a small, U-shaped bone in the neck that supports the tongue and its muscles. This procedure involves repairing or stabilizing the bone to ensure proper healing and function.
When billing for the treatment of a hyoid bone fracture using CPT code 21494, 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 21494, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or unusual circumstances that increased the complexity of the treatment.
2. Modifier 51 (Multiple Procedures): If multiple procedures were performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
3. Modifier 52 (Reduced Services): Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 (Discontinued Procedure): Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
5. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 (Repeat Procedure by Same Physician): If the same physician needs to repeat the procedure on the same day, this modifier should be used.
7. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier if a different physician repeats the procedure on the same day.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 (Assistant Surgeon): Use this modifier if an assistant surgeon was necessary for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon was required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Apply this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Use this modifier if a non-physician practitioner assisted in the surgery.
14. Modifier LT (Left Side): If the procedure was performed on the left side of the body, this modifier should be used.
15. Modifier RT (Right Side): If the procedure was performed on the right side of the body, this modifier should be used.
16. Modifier 99 (Multiple Modifiers): Use this modifier if multiple modifiers are necessary to describe the service provided.
By appropriately applying these modifiers, healthcare providers can ensure that their claims are processed accurately and efficiently, leading to optimal reimbursement and compliance with payer guidelines.
Medicare reimbursement for CPT code 21494, which pertains to the treatment of a hyoid bone fracture, depends on several factors including the setting in which the service is provided (e.g., inpatient, outpatient, or physician's office), the specific Medicare Administrative Contractor (MAC) jurisdiction, and whether the service is deemed medically necessary.
As of the latest available data, Medicare does reimburse for CPT code 21494 when the procedure is performed in a medically necessary context. However, the exact reimbursement amount can vary. For instance, in a physician's office setting, the Medicare Physician Fee Schedule (MPFS) may list a specific allowable amount, which could be different from the reimbursement rate in a hospital outpatient setting.
To get the most accurate and up-to-date reimbursement rate for CPT code 21494, healthcare providers should refer to the Medicare Physician Fee Schedule Lookup Tool available on the Centers for Medicare & Medicaid Services (CMS) website or consult their specific MAC.
For example, as of the latest update, the national average reimbursement rate for CPT code 21494 in a non-facility setting might be approximately $500, but this amount can vary based on geographic adjustments and other factors. Always verify with the most current CMS resources or your MAC for precise figures.
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 21494 for treating hyoid bone fractures. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and safeguard 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
