CPT code 29055 is for the application of a shoulder cast, used to immobilize and support the shoulder during healing.
CPT code 29055 is for the application of a shoulder cast. This procedure involves immobilizing the shoulder joint to promote healing after an injury or surgery. The cast is designed to restrict movement and provide support, ensuring that the affected area remains stable during the recovery process.
When billing for CPT code 29055, which pertains to the application of a shoulder 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 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both shoulders.
2. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left shoulder.
3. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right shoulder.
4. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required, justifying additional reimbursement.
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 if the procedure is performed separately from other procedures on the same day, indicating that it is not part of a bundled service.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if the procedure is repeated for diagnostic purposes, although this is less common for casting procedures.
8. Modifier 95 - Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System: Use this modifier if the procedure is conducted via telemedicine, although this is typically not applicable for casting.
Each of these modifiers serves to provide additional context for the billing process, ensuring that the services rendered are accurately represented and reimbursed appropriately.
The CPT code 29055 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors.
To determine the specific reimbursement rate, you should refer to the Medicare Physician Fee Schedule (MPFS), which provides detailed information on the payment rates for various CPT codes.
Additionally, the reimbursement may be subject to local adjustments and policies set by the Medicare Administrative Contractor (MAC) for your region.
It is essential to consult both the MPFS and your regional MAC to get accurate and up-to-date information on the reimbursement for CPT code 29055.
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 29055, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can optimize your financial performance.
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
