CPT code 26492 is a medical billing code for a tendon transfer procedure that involves using a graft to repair or reconstruct tendons.
CPT code 26492 is a procedure that involves the surgical transfer of a tendon, which may include the use of a graft. This procedure is typically performed to restore function or improve movement in a joint or limb by repositioning a tendon to a new location, often to compensate for a damaged or non-functioning tendon. The use of a graft may be necessary to reinforce the tendon or to bridge a gap where the tendon has been injured or removed.
When billing for the CPT code 26492 (Tendon transfer with graft), several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 50 - Bilateral Procedure: This modifier indicates that the procedure was performed on both sides of the body.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session, indicating that the primary procedure is being billed along with additional procedures.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if the tendon transfer is part of a staged procedure or if it is a related procedure performed during the postoperative period of a previous surgery.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate if the tendon transfer with graft is repeated on the same day by the same physician.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure: This modifier is used if the patient requires an unplanned return to the operating room for a related procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier indicates that a procedure unrelated to the original procedure is performed during the postoperative period.
8. Modifier RT - Right Side: This modifier specifies that the procedure was performed on the right side of the body.
9. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left side of the body.
10. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 26492 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 covered by Medicare, along with the corresponding reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 26492 can also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and may have additional local coverage determinations (LCDs) that affect whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult both the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 26492.
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