CPT code 23600 is for the closed treatment of a proximal humeral fracture without manipulation.
CPT code 23600 is used to describe the closed treatment of a proximal humeral (upper arm bone) fracture without manipulation. This means that the healthcare provider treats the fracture without needing to manually adjust or realign the bone. This procedure typically involves immobilization techniques such as using a sling or brace to allow the bone to heal naturally.
For CPT code 23600 (Closed treatment of proximal humeral fracture without manipulation), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used when an evaluation and management service performed during a postoperative period is unrelated to the original 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: Used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the procedure.
4. Modifier 26 - Professional Component: Used when only the professional component of a service is being billed.
5. Modifier 32 - Mandated Services: Used when services are required by a third party, such as an insurance company or government agency.
6. Modifier 50 - Bilateral Procedure: Used when the same procedure is performed on both sides of the body.
7. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
8. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
9. Modifier 54 - Surgical Care Only: Used when only the surgical care portion of a service is being billed.
10. Modifier 55 - Postoperative Management Only: Used when only the postoperative management portion of a service is being billed.
11. Modifier 56 - Preoperative Management Only: Used when only the preoperative management portion of a service is being billed.
12. Modifier 57 - Decision for Surgery: Used when an evaluation and management service results in the initial decision to perform surgery.
13. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used when a procedure or service during the postoperative period was planned or anticipated.
14. 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.
15. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician.
16. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician.
17. 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 when a related procedure is performed during the postoperative period.
18. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
19. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during a procedure.
20. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during a procedure.
21. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
22. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when a clinical diagnostic laboratory test is repeated.
23. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 23600 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including CPT code 23600. To determine the exact reimbursement amount, healthcare providers should refer to the MPFS, which is updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding the reimbursement for CPT code 23600. Providers should consult their respective MAC for detailed guidance on billing and reimbursement for this code.
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