CPT code 48554 is a medical billing code used to describe the transplantation of an allograft pancreas.
CPT code 48554 is used to describe the surgical procedure of transplanting an allograft pancreas. This involves the transfer of a pancreas from a donor to a recipient, typically performed to treat conditions such as diabetes or pancreatic failure. The code specifically indicates that the pancreas is obtained from a living or deceased donor and is intended to restore normal pancreatic function in the recipient.
For CPT code 48554 (Transpl allograft pancreas), 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 52 - Reduced Services: Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure: Used when a procedure is terminated 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.
5. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 66 - Surgical Team: When a highly complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service was repeated by another physician subsequent to the original procedure or service.
9. 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.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: When an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: When an assistant surgeon provides minimal assistance during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when a qualified resident surgeon is not available, and an assistant surgeon is required.
14. Modifier 99 - Multiple Modifiers: When two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 48554 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and consult with your local Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 48554. Additionally, MACs can offer region-specific insights and any additional requirements or documentation needed for successful reimbursement.
Always ensure to stay updated with the latest guidelines from both the MPFS and your MAC to optimize your revenue cycle management.
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