CPT code 25505 is for the treatment of a radius fracture, detailing the specific medical procedure used to address this type of injury.
CPT code 25515 is used to describe the surgical treatment of a fracture in the radius, which is one of the two bones in the forearm. This code specifically refers to the procedure where the fracture is treated without the need for manipulation or reduction, meaning the bone is not realigned manually. This code is typically used when the fracture is stable and can be managed with immobilization techniques such as casting or splinting.
For CPT code 25515, which pertains to the treatment of a fracture of the radius, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is an ordered list of potential modifiers and the reasons for their use:
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 50 - Bilateral Procedure
- Used when the procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same session by the same provider.
6. Modifier 52 - Reduced Services
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure
- Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 54 - Surgical Care Only
- Used when the physician performs only the surgical portion of the service.
9. Modifier 55 - Postoperative Management Only
- Used when the physician performs only the postoperative management of the service.
10. Modifier 56 - Preoperative Management Only
- Used when the physician performs only the preoperative management of the service.
11. Modifier 57 - Decision for Surgery
- Used when an evaluation and management service results in the initial decision to perform surgery.
12. 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 (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
13. 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.
14. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
15. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
16. 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.
17. 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.
18. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
19. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
20. 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.
21. 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.
The CPT code 25515 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and practice costs. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and determining coverage specifics within their jurisdictions. Therefore, it is advisable to consult the MPFS and the relevant MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 25515.
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