CPT code 29035 is a medical billing code used for the application of a body cast in healthcare settings.
CPT code 29035 is used to describe the procedure of applying a body cast. This code specifically refers to the process of immobilizing a part of the body, typically to support healing after a fracture or injury. The application of a body cast involves the use of plaster or fiberglass material to encase the affected area, ensuring stability and protection during the recovery period.
When billing for CPT code 29035 (Application of body cast), 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 22 - Increased Procedural Services: This modifier may be used if the application of the body cast required significantly more work than typically required for the procedure.
2. Modifier 50 - Bilateral Procedure: If the body cast is applied to both sides of the body, this modifier indicates that the procedure was performed bilaterally.
3. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session, indicating that the body cast application is one of several procedures.
4. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the body cast application is performed separately from other procedures that may be billed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: If the body cast application is performed again by the same physician on the same day, this modifier indicates that it is a repeat procedure.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician performs the same procedure on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: If the patient requires a return to the operating room for complications related to the body cast application, this modifier should be used.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if a different procedure is performed by the same physician during the postoperative period of the body cast application.
9. Modifier KX - Requirements Met: This modifier is used to indicate that the requirements for coverage of the procedure have been met, often necessary for insurance purposes.
10. Modifier LT - Left Side: If the body cast is applied specifically to the left side of the body, this modifier should be used.
11. Modifier RT - Right Side: Conversely, if the body cast is applied specifically to the right side of the body, this modifier is appropriate.
Each of these modifiers serves to provide additional context to the procedure being billed, ensuring accurate reimbursement and compliance with payer requirements.
CPT code 29035 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect reimbursement for CPT code 29035. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies in your area.
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