CPT code 24125 is for the excision or curettage of a bone cyst or tumor in the radius or ulna with a bone graft.
CPT code 24126 is used to describe the surgical procedure for the excision or curettage of a bone cyst or tumor in the radius or ulna. This code is specifically for cases where the cyst or tumor is located in these bones of the forearm and involves the removal or scraping out of the abnormal growth. This procedure is typically performed to alleviate pain, prevent fractures, or address other complications associated with the bone cyst or tumor.
For CPT code 24126 (Excision or curettage of bone cyst or benign tumor, radius), 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.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both radii, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier should be used.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier is appropriate.
5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier should be appended.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is applicable.
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: This modifier is used when the patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier LT - Left Side: If the procedure is performed on the left radius, this modifier should be used.
11. Modifier RT - Right Side: If the procedure is performed on the right radius, this modifier should be used.
12. Modifier 99 - Multiple Modifiers: When more than one modifier is necessary, this modifier indicates that multiple modifiers are being used.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 24126 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually. To determine the exact reimbursement rate for CPT code 24126, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and ensuring that they comply with Medicare guidelines. They may have local coverage determinations (LCDs) that provide further details on the conditions under which CPT code 24126 is reimbursed. Therefore, it is essential for healthcare providers to consult both the MPFS and their respective MACs to ensure accurate billing and reimbursement for CPT code 24126.
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