CPT code 36573 is used for inserting a peripherally inserted central catheter (PICC) with imaging guidance in patients aged 5 years and older.
CPT code 36573 is used to describe the procedure of inserting a peripherally inserted central catheter (PICC) with imaging guidance for patients aged 5 years and older. This code specifically indicates that the insertion of the PICC line is performed with the assistance of imaging techniques, such as ultrasound or fluoroscopy, to ensure accurate placement of the catheter. This procedure is typically used for patients who require long-term intravenous access for treatments such as medication administration, nutrition, or chemotherapy. The use of imaging guidance helps enhance the precision and safety of the catheter placement.
For CPT code 36573, which involves the insertion of a peripherally inserted central catheter (PICC) with imaging guidance for patients aged 5 years and older, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of the service is being billed separately from the technical component. It is applicable if the provider is only performing the interpretation of the imaging guidance.
2. Modifier TC - Technical Component: This modifier is used when the technical component of the service is being billed separately from the professional component. It is applicable if the provider is only responsible for the technical aspect of the imaging guidance.
3. 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.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day. It may be applicable if the PICC insertion needs to be repeated due to complications or other clinical reasons.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It may be applicable if another provider needs to perform the PICC insertion.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used when a related procedure is performed during the postoperative period due to complications. It may be applicable if the patient needs to return for a related procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period. It may be applicable if a different, unrelated procedure is necessary.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 36573 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) is the primary tool used to determine the reimbursement rates for services covered under Medicare Part B, including those associated with CPT code 36573. The MPFS outlines the payment rates for each service, which are updated annually to reflect changes in practice costs, geographic adjustments, and policy updates.
However, the reimbursement for CPT code 36573 can also vary based on the specific Medicare Administrative Contractor (MAC) that processes claims in your region. MACs are responsible for interpreting national Medicare policies and applying them to local circumstances, which can result in variations in coverage and payment. Therefore, it is crucial for healthcare providers to verify the specific reimbursement details with their local MAC to ensure compliance and accurate billing practices.
In summary, while CPT code 36573 is generally reimbursed by Medicare, the exact reimbursement amount and conditions may vary depending on the MPFS and the guidelines set forth by the relevant MAC.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments at the CPT code level, including CPT code 36573, and by individual payer. Schedule a demo today to see how RevFind can help you capture every dollar you deserve.
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
