CPT code 21554 is for the surgical removal of a deep tumor in the neck that is 5 cm or larger.
CPT code 21554 is used for the surgical procedure involving the excision (removal) of a deep tumor located in the neck that is 5 centimeters or larger in size. This code specifically applies to tumors that are situated beneath the superficial layers of tissue, requiring a more complex and invasive surgical approach.
When billing for CPT code 21554 (Excision of tumor, soft tissue of neck or anterior thorax, deep, 5 cm or greater), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
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 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, other than E/M services, are performed at the same session by the same provider.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the procedure needs to be repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the procedure is repeated by a different provider.
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
- Use this modifier if the patient requires an unplanned 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 provider during the postoperative period of the initial procedure.
10. Modifier LT - Left Side
- Use this modifier to specify that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- Apply this modifier to specify that the procedure was performed on the right side of the body.
12. Modifier 99 - Multiple Modifiers
- Use this modifier when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT coding guidelines and payer-specific requirements for the most accurate and up-to-date information.
Medicare reimbursement for CPT code 21554, which pertains to the excision of a deep tumor in the neck measuring 5 cm or greater, is subject to several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., inpatient, outpatient, or ambulatory surgical center), and the patient's specific Medicare plan.
As of the latest available data, Medicare does reimburse for CPT code 21554. The reimbursement amount can vary based on geographic location and other factors. For instance, in an outpatient setting, the national average reimbursement rate for this procedure might range from approximately $1,200 to $1,500. However, these figures are subject to change and should be verified with the latest Medicare Physician Fee Schedule (MPFS) or through direct inquiry with the relevant MAC.
Healthcare providers should consult the most recent MPFS and their local MAC for precise reimbursement rates and any specific billing guidelines that may apply.
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 21554 for excision of neck tumors deeper than 5 cm. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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