CPT code 21933 is for the surgical removal of a deep tumor from the back, measuring 5 cm or more.
CPT code 21933 is for the surgical procedure that involves the excision (removal) of a deep tumor located in the back, with the tumor size being 5 centimeters or larger.
For CPT code 21933 (Excision, tumor, soft tissue of back or flank, subfascial (e.g., intramuscular); 5 cm or greater), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as the complexity of the tumor or patient anatomy.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both sides of the body, this modifier should be used to indicate that the excision was bilateral.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
4. Modifier 59 (Distinct Procedural Service): Used to indicate that the procedure was distinct or independent from other services performed on the same day. This could be due to different anatomical sites or separate incisions.
5. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure is repeated by the same physician, this modifier should be used to indicate the repetition.
6. Modifier 77 (Repeat Procedure by Another Physician): If the procedure is repeated by a different physician, this modifier is used to indicate the repetition by another provider.
7. 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.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, this modifier should be used to indicate their involvement.
10. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Used when a non-physician practitioner assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
When determining if a specific CPT code, such as 21933 (Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greater), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) provided by Medicare Administrative Contractors (MACs).
As of the latest update, CPT code 21933 is reimbursed by Medicare. The reimbursement amount can vary based on geographic location and other factors. For a more precise figure, healthcare providers should refer to the MPFS Look-Up Tool available on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC.
For example, in 2023, the national average reimbursement for CPT code 21933 is approximately $1,200. However, this amount can differ based on locality adjustments and other considerations. Always verify the current rates and policies to ensure accurate billing and reimbursement.
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 21933 for excision of back tumors deeper than 5 cm. 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
