CPT code 22315 is for the closed treatment of a vertebral fracture with manipulation.
CPT code 22315 is for the closed treatment of a vertebral fracture with manipulation. This means that a healthcare provider treats a broken vertebra in the spine without making an incision, using manual techniques to realign the bone.
For CPT code 22315, which refers to the closed treatment of vertebral fracture(s) with manipulation, 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. Documentation must support the substantial additional work.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Apply this modifier if an unrelated E/M service is performed by the same physician during the postoperative period of the initial procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Use this modifier when a significant, separately identifiable E/M service is provided by the same physician on the same day as the procedure.
4. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed, typically applicable in cases where the service includes both professional and technical components.
5. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure is performed bilaterally.
6. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same session by the same provider.
7. Modifier 52 - Reduced Services
- This modifier is used when the service or procedure is partially reduced or eliminated at the physician's discretion.
8. 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.
9. Modifier 54 - Surgical Care Only
- Use this modifier when the physician performs the surgical care only, and another provider is responsible for preoperative and postoperative care.
10. Modifier 55 - Postoperative Management Only
- This modifier is used when the physician provides only the postoperative management.
11. Modifier 56 - Preoperative Management Only
- Apply this modifier when the physician provides only the preoperative management.
12. 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.
13. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
14. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier when a procedure or service is repeated by another physician or other qualified healthcare professional.
15. 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.
16. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
17. Modifier 80 - Assistant Surgeon
- Apply this modifier when an assistant surgeon is required for the procedure.
18. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when a minimum assistant surgeon is required for the procedure.
19. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
20. Modifier 99 - Multiple Modifiers
- Apply this modifier when multiple modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
Determining whether a specific CPT code, such as 22315 (Closed treatment of vertebral fracture(s) with manipulation), is reimbursed by Medicare involves several steps. Medicare reimbursement policies can vary based on several factors, including the setting in which the service is provided (e.g., inpatient vs. outpatient), the patient's specific Medicare plan, and regional Medicare Administrative Contractor (MAC) guidelines.
1. Medicare Coverage Database: The first step is to consult the Medicare Coverage Database (MCD) to check if there are any National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs) that apply to CPT code 22315. These documents provide detailed information on whether a service is covered and under what conditions.
2. Fee Schedules: Medicare reimbursement rates for specific CPT codes can be found in the Medicare Physician Fee Schedule (MPFS). This schedule outlines the payment rates for services provided by physicians and other healthcare professionals. The reimbursement amount can vary based on geographic location due to the Geographic Practice Cost Index (GPCI).
3. Medicare Administrative Contractors (MACs): Each MAC may have specific guidelines and fee schedules that apply to their region. Checking with the relevant MAC for your area can provide the most accurate and up-to-date information on reimbursement for CPT code 22315.
4. Billing and Coding Resources: Utilize resources such as the American Medical Association (AMA) and specialty-specific coding guides to ensure that the code is billed correctly and that all necessary documentation is provided to support the claim.
As of the latest available data, the national average reimbursement rate for CPT code 22315 under the Medicare Physician Fee Schedule is approximately $300-$400. However, this amount can vary based on the factors mentioned above.
For the most accurate and specific information, healthcare providers should consult the latest MPFS, their regional MAC, and any applicable NCDs or LCDs.
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 22315 for closed treatment of vertebral fractures with manipulation. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect 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
