CPT code 28455 is used to describe the treatment of a midfoot fracture in each foot, detailing the specific procedure performed.
CPT code 28455 is used to describe the treatment of a midfoot fracture in each foot. This code specifically refers to the surgical procedure involved in stabilizing and repairing fractures located in the midfoot region, which includes the bones between the hindfoot and forefoot. The code indicates that the procedure is performed on each affected midfoot, highlighting the complexity and the need for careful management of the injury.
When billing for CPT code 28455, there are several modifiers that 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 51 - Multiple Procedures: This modifier is appropriate if multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side: Use this modifier 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 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated by a different physician on the same day.
8. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is relevant if an unrelated service is provided during the postoperative period of the procedure.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is used when a patient has multiple encounters on the same day.
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.
CPT code 28455 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 28455 may also depend on the policies of the local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can have region-specific guidelines that influence whether and how a particular CPT code is reimbursed. Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate billing and reimbursement for CPT code 28455.
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