CPT code 35495 is used for a percutaneous atherectomy, a procedure to remove plaque from blood vessels to improve blood flow.
CPT code 35495 is used to describe a percutaneous atherectomy procedure. This procedure involves the removal of plaque from a blood vessel using a catheter-based technique. It is typically performed to restore proper blood flow in cases where arteries have become narrowed or blocked due to the buildup of fatty deposits. The procedure is minimally invasive, meaning it is done through a small incision, and is often used as an alternative to more invasive surgical options.
For CPT code 35495, which pertains to percutaneous atherectomy, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:
1. Modifier 50 - Bilateral Procedure: Used when 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.
4. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs the atherectomy more than once on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: Applied when a different physician performs the atherectomy more than once 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 to the operating room for a related 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 performed during the postoperative period of another procedure but is unrelated to the initial surgery.
8. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the atherectomy procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied when an assistant surgeon is necessary, and a qualified resident is unavailable.
10. Modifier 99 - Multiple Modifiers: Used when more than four modifiers are necessary to describe the procedure accurately.
These modifiers help provide additional information about the circumstances under which the atherectomy was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
CPT code 35495, which involves atherectomy percutaneous, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether a particular CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals, and CPT code 35495 would be included in this schedule if it is deemed reimbursable.
Additionally, Medicare Administrative Contractors (MACs) are responsible for processing claims and have the authority to make determinations regarding coverage and reimbursement for specific CPT codes within their jurisdictions. MACs may have local coverage determinations (LCDs) that provide guidance on the medical necessity and coverage criteria for procedures like those associated with CPT code 35495.
Therefore, while CPT code 35495 can be reimbursed by Medicare, healthcare providers should verify the specific reimbursement details and any applicable coverage criteria through the MPFS and consult with their respective MAC to ensure compliance with local policies.
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