CPT code 22514 is for percutaneous vertebral augmentation, a procedure to stabilize spinal fractures.
CPT code 22514 is for a procedure called percutaneous vertebral augmentation. This involves the injection of a special cement-like material into a fractured vertebra in the spine to stabilize it and relieve pain.
For CPT code 22514 (Percutaneous vertebral augmentation), the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician.
5. Modifier 77 - Repeat Procedure by Another Physician: Applied when the same procedure is repeated by a different physician.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. 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.
8. Modifier LT - Left Side: Indicates that the procedure was performed on the left side of the body.
9. Modifier RT - Right Side: Indicates that the procedure was performed on the right side of the body.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these healthcare professionals assist in the surgery.
11. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician: Used in teaching settings where a resident is involved in the procedure under the supervision of a teaching physician.
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 22514: Percutaneous Vertebral Augmentation
CPT code 22514 pertains to percutaneous vertebral augmentation, a minimally invasive procedure often used to treat vertebral compression fractures. Medicare does provide reimbursement for this procedure under specific conditions, primarily when it is deemed medically necessary for the patient.
The reimbursement amount for CPT code 22514 can vary based on several factors, including geographic location, the setting in which the procedure is performed (e.g., hospital outpatient department vs. ambulatory surgical center), and any applicable adjustments such as the Medicare Physician Fee Schedule (MPFS).
As of the latest available data, the national average reimbursement rate for CPT code 22514 under the MPFS is approximately $1,200 to $1,500. However, it is crucial to verify the exact reimbursement rate through the Medicare Administrative Contractor (MAC) for your specific region, as rates can fluctuate and are subject to annual updates.
For the most accurate and up-to-date information, healthcare providers should consult the Medicare Fee Schedule Lookup Tool or contact their local MAC. This ensures compliance with Medicare guidelines and helps in accurate financial planning and revenue cycle management.
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 22514 for percutaneous vertebral augmentation. Ensure you're receiving accurate reimbursements from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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