CPT code 42400 is for a biopsy of the salivary gland, used to identify diseases or conditions affecting this gland.
CPT code 42400 is for a biopsy of the salivary gland. This procedure involves the removal of a small sample of tissue from a salivary gland for diagnostic examination. It is typically performed to investigate abnormalities such as tumors, infections, or other conditions affecting the salivary glands. The biopsy helps healthcare providers determine the nature of the issue and guide further treatment decisions.
For CPT code 42400 (Biopsy of salivary gland), 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.
2. Modifier 50 - Bilateral Procedure: Used if the biopsy is performed on both salivary glands during the same session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the service provided is less than the usual service described by the CPT code.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
8. 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 related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
Determining if CPT code 42400 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 42400 is reimbursed, you would need to check the MPFS database. This can be done through the Centers for Medicare & Medicaid Services (CMS) website or by using specialized software that accesses the MPFS. Additionally, MACs, which are regional contractors responsible for processing Medicare claims, may have specific guidelines or local coverage determinations (LCDs) that affect reimbursement for this code.
In summary, to determine if CPT code 42400 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC for any specific regional guidelines or coverage determinations.
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