CPT code 28114 is for the surgical removal of metatarsal heads, a procedure often performed to alleviate foot pain or deformities.
CPT code 28114 is the procedure for the surgical removal of metatarsal heads, which are the rounded ends of the metatarsal bones in the foot. This procedure is typically performed to alleviate pain or correct deformities in the forefoot, often due to conditions such as arthritis, bunions, or other foot-related issues. The removal of metatarsal heads can help improve foot function and enhance the patient's quality of life by reducing discomfort during movement.
When billing for the CPT code 28114, the following modifiers may be applicable, depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both feet (bilateral).
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left foot.
5. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated by the same physician on the same day.
7. 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 postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a different procedure is performed by the same physician during the postoperative period of the initial procedure.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and compliance with payer requirements.
CPT code 28114 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 and the corresponding payment rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement for CPT code 28114. MACs are responsible for processing Medicare claims and can provide further guidance on any regional variations or specific documentation requirements needed for reimbursement.
Therefore, it is essential to consult the MPFS and your local MAC to ensure compliance and accurate reimbursement for CPT code 28114.
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