CPT code 42182 is for the surgical repair of the palate, a procedure to correct defects in the roof of the mouth.
CPT code 42182 is used to describe a surgical procedure for the repair of the palate, specifically addressing conditions such as cleft palate or other defects. This code indicates that the procedure involves reconstructing or closing the opening in the roof of the mouth to restore normal function and appearance.
For CPT code 42182 (Repair palate), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 52 - Reduced Services: Applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same provider subsequent to the original procedure or service.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Applied when a procedure or service is repeated by a different provider than the one who performed the original procedure.
7. 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 when a patient requires a return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 42182 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for specific CPT codes. Therefore, it is advisable to consult the MPFS and your regional MAC to confirm the reimbursement status and any specific requirements for CPT code 42182.
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