CPT code 21556 is for the surgical removal of a deep tumor in the neck that is less than 5 cm in size.
CPT code 21556 is used for the surgical procedure involving the excision (removal) of a deep tumor located in the neck that is less than 5 centimeters in size.
For CPT code 21556, which refers to the excision of a neck tumor that is deep and less than 5 cm, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure is performed on both sides of the neck during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team
- Apply this modifier when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician repeats the procedure on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure performed by another physician is repeated on the same day.
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
- Apply this modifier if the patient needs to 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
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare reimbursement for CPT code 21556, which refers to the excision of a neck tumor that is deep and less than 5 cm, is subject to several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., hospital outpatient, inpatient, or ambulatory surgical center), and the patient's specific Medicare plan.
As of the latest available data, Medicare does reimburse for CPT code 21556. The reimbursement amount can vary based on geographic location and other factors. For instance, the national average payment for this procedure in a hospital outpatient setting might be approximately $1,200 to $1,500. However, these amounts are subject to change and should be verified with the latest Medicare Physician Fee Schedule (MPFS) or through direct consultation with the relevant MAC.
For the most accurate and up-to-date reimbursement information, healthcare providers should refer to the Medicare Physician Fee Schedule Look-Up Tool available on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC.
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