CPT code 36514 is used for apheresis plasma, a procedure where plasma is separated and removed from the blood for therapeutic purposes.
CPT code 36514 is used to describe the procedure of apheresis plasma. This code is specifically assigned to the process where blood is drawn from a patient, and the plasma component is separated and removed. The remaining blood components, such as red blood cells, white blood cells, and platelets, are then returned to the patient's circulation. Apheresis plasma is often utilized in the treatment of various medical conditions, such as autoimmune disorders, where removing certain antibodies or proteins from the plasma can be beneficial. This procedure requires specialized equipment and trained healthcare professionals to ensure safety and efficacy.
For CPT code 36514, which pertains to apheresis plasma, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if multiple procedures are performed and need to be reported separately.
2. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician or healthcare provider on the same day. It helps in distinguishing the repeated service from the initial one.
3. Modifier 77 (Repeat Procedure by Another Physician): Similar to Modifier 76, this is used when the procedure is repeated on the same day but by a different physician or healthcare provider.
4. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can be applicable if the apheresis procedure is repeated for clinical reasons on the same day.
5. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the discretion of the physician or healthcare provider.
6. Modifier 53 (Discontinued Procedure): This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
7. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
These modifiers help in providing additional information about the services rendered and ensure accurate billing and reimbursement. It is important to use them appropriately to avoid claim denials or delays.
The CPT code 36514 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually.
However, the actual reimbursement for CPT code 36514 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for interpreting national Medicare policies and setting local coverage determinations, which can influence whether and how a particular service is reimbursed.
Therefore, healthcare providers should consult their specific MAC for detailed information on the reimbursement criteria and rates for CPT code 36514.
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