CPT code 21601 is for the surgical removal of a chest wall tumor, including the resection of ribs.
CPT code 21601 is for the surgical procedure that involves the excision (removal) of a tumor located in the chest wall, which includes the removal of one or more ribs. This code is used by healthcare providers to document and bill for this specific type of surgery.
For CPT code 21601 (Excision of chest wall tumor including ribs), 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. This could be due to the size or location of the tumor, or other complicating factors.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the chest, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier should be used to indicate that both surgeons were necessary.
6. Modifier 66 - Surgical Team: If the procedure requires a surgical team, this modifier should be appended.
7. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure, this modifier should be used.
8. Modifier 77 - Repeat Procedure by Another Physician: If another physician needs to repeat the procedure, this modifier should be used.
9. 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 needs to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required, this modifier should be appended.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier if a PA, NP, or CNS assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining whether a specific CPT code, such as 21601 (Excision of chest wall tumor including ribs), is reimbursed by Medicare involves several steps. Medicare reimbursement is contingent upon various factors including medical necessity, proper documentation, and adherence to Medicare guidelines.
For CPT code 21601, Medicare does provide reimbursement, but the exact amount can vary based on geographic location, the setting in which the procedure is performed (e.g., hospital outpatient department vs. inpatient), and other factors such as the Medicare Physician Fee Schedule (MPFS) and any applicable adjustments.
As of the most recent data, the national average reimbursement rate for CPT code 21601 under the Medicare Physician Fee Schedule is approximately $1,500. However, this amount can fluctuate based on the aforementioned factors. Providers should consult the latest MPFS and their local Medicare Administrative Contractor (MAC) for the most accurate and up-to-date reimbursement information.
To ensure proper reimbursement, healthcare providers must also ensure that the procedure is medically necessary and well-documented, and that all Medicare billing guidelines are strictly followed.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 21601 for excision of chest wall tumors with ribs. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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
