CPT code 37251 is used for reporting an additional intravascular ultrasound procedure performed on each extra vessel during a medical intervention.
CPT code 37251 is an add-on code used to describe the procedure of intravascular ultrasound (IVUS) performed on each additional vessel beyond the primary vessel. This code is utilized when a healthcare provider conducts an IVUS, which is a diagnostic procedure that uses a specially designed catheter with an ultrasound probe to visualize the inside of blood vessels. The purpose of this procedure is to assess the vessel's condition, including the presence of blockages or other abnormalities. As an add-on code, 37251 is used in conjunction with a primary procedure code to indicate that additional vessels were examined during the same session.
For CPT code 37251, which pertains to intravascular ultrasound (IVUS) for each additional vessel as an add-on, 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 indicates that the physician's services, such as interpretation and report, are being billed.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the billing is for the use of equipment and technical staff.
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 XS - Separate Structure: This modifier is used to indicate that a service was performed on a separate organ/structure. It can be used to clarify that the procedure was distinct from other procedures performed on different anatomical sites.
5. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session. It helps to indicate that more than one procedure was performed and may affect reimbursement.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure is repeated by the same physician on the same day. It indicates that the procedure was necessary to be performed again.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician on the same day. It indicates that the procedure was necessary to be performed again by another provider.
These modifiers help provide additional information to payers about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 37251, which is an add-on code, is subject to reimbursement by Medicare, but its reimbursement is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for services covered under Medicare Part B. However, add-on codes like 37251 are typically reimbursed only when billed in conjunction with a primary procedure code that is also covered by Medicare.
Furthermore, the reimbursement for CPT code 37251 can vary based on the policies of the Medicare Administrative Contractor (MAC) that processes claims in your specific geographic region. Each MAC may have specific guidelines and coverage determinations that influence whether and how much a particular service is reimbursed. Therefore, it is crucial for healthcare providers to verify the coverage and reimbursement specifics with their local MAC and ensure that the primary procedure code is also eligible for reimbursement under the MPFS.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 37251, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
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
