CPT code 35494 is used for a procedure involving the removal of plaque from blood vessels through a minimally invasive technique.
CPT code 35494 is used to describe a percutaneous atherectomy procedure. This is a minimally invasive surgical technique used to remove plaque from blood vessels. The procedure involves the insertion of a catheter with a specialized cutting device into the affected artery to clear blockages and improve blood flow. This code is typically used by healthcare providers to document and bill for the procedure when performed to treat conditions such as peripheral artery disease.
For CPT code 35494, which pertains to percutaneous atherectomy, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: Used if the atherectomy is performed on both sides of the body during the same session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures, including the atherectomy, are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service: Utilized to indicate that the atherectomy is a distinct service from other procedures performed on the same day, which are not normally reported together.
4. Modifier 76 - Repeat Procedure by Same Physician: Used if the atherectomy procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: Applied when the atherectomy is repeated by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient returns for an additional atherectomy related to the initial procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Applied when the atherectomy is unrelated to the original procedure and occurs during the postoperative period.
8. Modifier 22 - Increased Procedural Services: Used if the atherectomy procedure required significantly more work than usual.
9. Modifier 62 - Two Surgeons: Applied when two surgeons are required to perform the atherectomy procedure together.
10. Modifier 66 - Surgical Team: Used if the atherectomy is performed by a surgical team due to the complexity of the procedure.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 35494, which involves a specific medical procedure, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually.
Additionally, it is crucial to consult with the local Medicare Administrative Contractor (MAC) for specific guidance. MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies, including any local coverage determinations (LCDs) that might affect reimbursement for CPT code 35494. These contractors can offer insights into whether the procedure is covered in specific regions and any documentation requirements that must be met for successful reimbursement.
In summary, while the MPFS is a starting point for understanding potential reimbursement for CPT code 35494, direct communication with the relevant MAC is essential to confirm coverage and ensure compliance with Medicare's billing requirements.
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