CPT code 23620 is for the closed treatment of a humeral tuberosity fracture without manipulation.
CPT code 23620 is used to describe the closed treatment of a humeral tuberosity fracture without manipulation. This means that the healthcare provider treats the fracture of the upper arm bone's tuberosity (a bony prominence) without needing to manually adjust or realign the bone. This procedure typically involves immobilization techniques such as casting or splinting to allow the bone to heal naturally.
For CPT code 23620 (Closed treatment of greater humeral tuberosity fracture without manipulation), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Use this modifier if an unrelated E/M service is performed during the postoperative period of another 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 if a significant, separately identifiable E/M service is provided on the same day as the procedure.
4. Modifier 26 - Professional Component: Use this modifier if only the professional component of the service is being billed.
5. Modifier 32 - Mandated Services: Use this modifier if the service is required by a third party, such as an insurance company or government agency.
6. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both sides of the body.
7. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures are performed during the same session.
8. Modifier 52 - Reduced Services: Use this modifier if the service provided is less than usually required.
9. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
10. Modifier 54 - Surgical Care Only: Use this modifier if only the surgical care portion of the service is being billed.
11. Modifier 55 - Postoperative Management Only: Use this modifier if only the postoperative care portion of the service is being billed.
12. Modifier 56 - Preoperative Management Only: Use this modifier if only the preoperative care portion of the service is being billed.
13. Modifier 57 - Decision for Surgery: Use this modifier if the E/M service resulted in the initial decision to perform the surgery.
14. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the procedure was planned or anticipated at the time of the original procedure.
15. Modifier 59 - Distinct Procedural Service: Use this modifier if a procedure or service is distinct or independent from other services performed on the same day.
16. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the same procedure is repeated by the same physician.
17. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure is repeated by a different physician.
18. 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 an unplanned return to the operating room is necessary.
19. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed during the postoperative period of another procedure.
20. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required during the procedure.
21. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
22. 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.
23. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if a clinical diagnostic laboratory test is repeated.
24. Modifier 99 - Multiple Modifiers: Use this modifier if multiple modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the service performed and ensure accurate billing and reimbursement.
The CPT code 23620 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding payment rates. Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 23620. Each MAC may have unique guidelines and policies, so ensuring compliance with their directives is vital for accurate and timely reimbursement.
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