CPT code 27614 is used to identify a biopsy procedure performed on soft tissue in the lower leg for diagnostic purposes.
CPT code 27614 is a code used to describe a biopsy procedure performed on the soft tissue of the lower leg. This code indicates that a sample of tissue has been taken from the lower leg area for diagnostic purposes, allowing healthcare providers to analyze the tissue for any abnormalities or diseases.
When billing for the CPT code 27614 (Biopsy lower leg soft tissue), 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. -50: Bilateral Procedure
Used when the procedure is performed on both legs.
2. -RT: Right Side
Indicates that the procedure was performed on the right leg.
3. -LT: Left Side
Indicates that the procedure was performed on the left leg.
4. -59: Distinct Procedural Service
Used to indicate that the biopsy is a separate and distinct procedure from other services performed on the same day.
5. -76: Repeat Procedure by Same Physician
Indicates that the same procedure was performed more than once by the same physician on the same day.
6. -77: Repeat Procedure by Another Physician
Indicates that the same procedure was performed more than once by a different physician on the same day.
7. -XU: Unusual Non-Overlapping Service
Used to indicate that the procedure is distinct because it does not overlap with other services provided.
8. -25: Significant, Separately Identifiable Evaluation and Management Service
Used when a significant and separately identifiable E/M service is performed on the same day as the biopsy.
9. -52: Reduced Services
Indicates that the service was reduced or not completed as planned.
10. -53: Discontinued Procedure
Used when the procedure was started but had to be discontinued due to extenuating circumstances.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and compliance with payer requirements.
The reimbursement of CPT code 27614 by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for your region.
To determine if CPT code 27614 is reimbursed by Medicare, you should first consult the MPFS, which lists the payment rates for services covered by Medicare. If CPT code 27614 is included in the MPFS, it is generally eligible for reimbursement, subject to any specific conditions or limitations.
Additionally, each MAC may have unique policies or additional requirements for reimbursement. Therefore, it is crucial to review the local coverage determinations (LCDs) and other relevant guidelines issued by your MAC to ensure compliance and confirm that CPT code 27614 is reimbursable in your jurisdiction.
In summary, while the MPFS provides a general framework for Medicare reimbursement, the final determination for CPT code 27614 will depend on the specific policies of your MAC.
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