CPT code 24115 is a medical code used to describe the excision or curettage of a bone cyst or tumor in the upper arm.
CPT code 24116 is used for the excision or curettage of a bone cyst or benign tumor in the upper arm (humerus) with the use of an allograft. This procedure involves surgically removing or scraping out a non-cancerous growth or cyst from the bone and then using donor bone tissue (allograft) to fill the space left behind, promoting healing and structural integrity.
For CPT code 24116 (Excision or curettage of bone cyst or benign tumor of the humerus), 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 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
8. 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 of the initial procedure.
9. 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.
10. Modifier LT - Left Side: Used to indicate that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side: Used to indicate that the procedure was performed on the right side of the body.
12. 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 performed procedure, ensuring accurate billing and reimbursement.
CPT code 24116 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. To determine the exact reimbursement for CPT code 24116, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining local coverage decisions. Each MAC may have specific guidelines and policies that can influence the reimbursement process for CPT code 24116. Therefore, it is advisable for healthcare providers to consult their respective MAC for detailed information on coverage and reimbursement rates for this particular code.
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