CPT code 27054 is for the removal of the hip joint lining, a procedure used to treat hip joint issues.
CPT code 27054 is the procedure for the removal of the lining of the hip joint. This surgical intervention is typically performed to alleviate pain or restore function in patients suffering from conditions such as arthritis or other joint disorders. The procedure involves accessing the hip joint and excising the synovial membrane, which can help reduce inflammation and improve mobility.
When billing for the CPT code 27054 (Removal of hip joint lining), 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: Use this modifier if the procedure is performed on both hips during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if the removal of the hip joint lining is performed in conjunction with other surgical procedures during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used when the procedure is performed separately and is not considered to be part of another procedure.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate if the procedure is repeated on the same hip by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if a different procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left hip.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right hip.
9. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier can be used if the procedure is performed by a non-physician practitioner under the supervision of a physician.
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.
The CPT code 27054 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, reimbursement for CPT code 27054 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your geographic area to confirm the specific reimbursement details for CPT code 27054.
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