CPT code 28295 is used to describe the surgical correction of hallux valgus, commonly known as a bunion.
CPT code 28295 is for the surgical correction of hallux valgus, commonly known as a bunion. This procedure involves realigning the big toe and correcting the bony prominence at the base of the toe to alleviate pain and improve function. It typically includes the removal of the bunion and may involve the repositioning of bones and soft tissues to restore proper alignment.
When billing for CPT code 28295, which pertains to the correction of hallux valgus, 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 feet.
2. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left foot.
3. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right foot.
4. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
6. 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.
7. Modifier 59 - Distinct Procedural Service: Use this modifier if the procedure is distinct or independent from other services performed on the same day.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if the procedure involves a repeat test or service that is necessary for the patient's care.
Each of these modifiers serves to provide additional context to the billing process, ensuring accurate reimbursement and compliance with payer requirements.
The CPT code 28295 is reimbursed by Medicare, but its reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and guidelines for various CPT codes, including 28295. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for this code. It is essential for healthcare providers to consult both the MPFS and their respective MACs to ensure compliance with Medicare's reimbursement criteria for CPT code 28295.
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. With RevFind, you can identify discrepancies for CPT code 28295 and ensure you are receiving the correct reimbursement. Schedule a demo today to see how RevFind can help you optimize your revenue.
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