CPT code 24498 is used for the surgical procedure to reinforce the humerus, typically involving the use of grafts or implants to strengthen the bone.
CPT code 24498 is used to describe a surgical procedure where the humerus (the upper arm bone) is reinforced. This typically involves the use of hardware, such as plates, screws, or rods, to stabilize and strengthen the bone, often after a fracture or in cases of bone weakening due to conditions like osteoporosis. This code ensures that the specific nature of the surgical intervention is accurately documented for billing and insurance purposes.
For CPT code 24498 (Reinforce humerus), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increase the complexity of the surgery.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both humeri during the same surgical session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that the procedure was one of several performed.
4. Modifier 52 - Reduced Services
- This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply 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
- Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used if the procedure was repeated by a different physician on the same day.
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
- Apply this modifier if the patient had to return 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 was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a non-physician practitioner assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 24498 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this code is covered and the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific guidance on coverage and reimbursement for CPT code 24498.
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