CPT code 26554 is a medical billing code for a double transfer procedure involving the toe and hand, used for accurate healthcare billing.
CPT code 26554 is used to describe a surgical procedure involving a double transfer of tendons in the hand and toes. This procedure typically aims to improve function or restore movement by relocating tendons from one area to another, allowing for better control and coordination of the affected digits. It is often performed in cases of congenital deformities or injuries that impair the use of the hand or foot.
When billing for CPT code 26554 (Double transfer toe-hand), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. 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.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Indicates that a procedure was repeated by the same provider.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
Used when a patient returns for a related procedure within the postoperative period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Indicates that a procedure was performed that is unrelated to the original procedure during the postoperative period.
7. Modifier LT - Left Side
Used to specify that the procedure was performed on the left side of the body.
8. Modifier RT - Right Side
Used to specify that the procedure was performed on the right side of the body.
9. Modifier 22 - Increased Procedural Services
Indicates that the work required to provide a service was substantially greater than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date
Used when a patient has multiple encounters on the same date of service.
It is essential to select the appropriate modifier(s) based on the specific details of the procedure performed to ensure accurate billing and compliance with payer requirements.
The CPT code 26554 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate.
The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts.
Additionally, reimbursement for CPT code 26554 may vary depending on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations.
Therefore, it is advisable to consult the relevant MAC for your area to confirm the reimbursement details for CPT code 26554.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. For instance, with CPT code 26554, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and address underpayments effectively.
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