CPT code 28490 is used to describe the treatment of a fracture in the big toe, detailing the specific medical procedure performed.
CPT code 28490 is used to describe the treatment of a fracture in the big toe. This code specifically refers to the surgical procedure involved in stabilizing and repairing the fracture to promote proper healing and restore function to the toe.
When billing for CPT code 28490, which pertains to the treatment of a big toe fracture, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both big toes.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if additional procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: This modifier is appropriate if the treatment is part of a staged procedure or if a subsequent procedure is planned during the postoperative period.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
5. Modifier 79 - Unrelated Procedure by Same Physician: This modifier is applicable if a different procedure is performed by the same physician during the postoperative period that is unrelated to the original procedure.
6. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
7. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: Use this modifier if an evaluation and management service is provided during the postoperative period that is unrelated to the original procedure.
8. Modifier 27 - Multiple Encounters on the Same Date: This modifier is applicable if multiple encounters occur on the same date of service.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and appropriate reimbursement.
The CPT code 28490 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, the reimbursement for CPT code 28490 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to interpret national policies and make local coverage determinations.
Therefore, it is essential to consult the relevant MAC for your region to confirm the specific reimbursement details and any additional requirements for CPT code 28490.
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 specific codes like 28490, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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