CPT code 28530 is used to describe the treatment of a sesamoid bone fracture in the foot, detailing the specific medical procedure performed.
CPT code 28530 is used to describe the treatment of a sesamoid bone fracture. This code specifically pertains to the medical procedures involved in addressing fractures of the sesamoid bones, which are small bones located within tendons, often found in the foot. The treatment may include various methods such as immobilization, surgical intervention, or other therapeutic approaches aimed at promoting healing and restoring function.
When billing for CPT code 28530, which pertains to the treatment of a sesamoid bone fracture, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both feet.
2. Modifier LT - Left Side: Use this modifier to indicate that the procedure was performed on the left foot.
3. Modifier RT - Right Side: Use this modifier to indicate that the procedure was 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 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if the procedure is repeated for the purpose of monitoring the patient's condition.
8. Modifier 52 - Reduced Services: Use this modifier if the service provided is less than what is typically required for the procedure.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and appropriate reimbursement.
The CPT code 28530 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate.
The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts.
Additionally, reimbursement for CPT code 28530 may vary based on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region.
Each MAC has the authority to interpret national Medicare policies and may have specific guidelines or requirements for reimbursement.
Therefore, it is advisable to consult the MPFS and your local MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 28530.
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. For instance, with RevFind, you can identify discrepancies related to CPT code 28530, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
