CPT CODES

CPT Code 49465

CPT code 49465 is a medical billing code for a fluoroscopic examination of a gastrocolonic tube.

Table of Contents
What is CPT Code 49465
Does CPT 49465 Need a Modifier?
CPT Code 49465 Medicare Reimbursement
Are You Being Underpaid for 49465 CPT Code?
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What is CPT Code 49465

CPT code 49465 is used to describe a fluoroscopic examination of a gastrostomy or colon tube. This procedure involves using real-time imaging to assess the placement and function of the tube within the gastrointestinal tract, ensuring that it is correctly positioned and functioning as intended for patient care.

Does CPT 49465 Need a Modifier?

When billing for CPT code 49465, which pertains to a fluoroscopic examination of a gastrointestinal/colon tube, the following modifiers may be applicable:

1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the fluoroscopic examination, not the technical component.

2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of the equipment and the technician's time, not the interpretation.

3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the fluoroscopic examination was a distinct service from other procedures performed on the same day. It helps to avoid bundling issues and ensures that the service is recognized as separate and necessary.

4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician performs the fluoroscopic examination more than once on the same day. It indicates that the repeat procedure was necessary and not a duplicate billing.

5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a different physician performs the fluoroscopic examination more than once on the same day. It indicates that the repeat procedure was necessary and performed by another provider.

6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the fluoroscopic examination is performed as an unplanned return to the procedure room for a related procedure during the postoperative period.

7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when the fluoroscopic examination is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.

8. Modifier 99 - Multiple Modifiers: This modifier is used when more than four modifiers are necessary to describe the service. It indicates that multiple modifiers are being applied to the CPT code.

These modifiers help to provide additional information about the circumstances under which the fluoroscopic examination was performed, ensuring accurate billing and reimbursement.

CPT Code 49465 Medicare Reimbursement

Determining if CPT code 49465 is reimbursed by Medicare involves checking the Medicare Physician Fee Schedule (MPFS) and consulting with your Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates under Medicare Part B. To confirm if CPT code 49465 is reimbursed, you would need to look it up in the MPFS database.

Additionally, MACs play a crucial role in processing Medicare claims and can provide region-specific information regarding coverage and reimbursement. Each MAC may have slightly different policies based on local coverage determinations (LCDs), so it's essential to verify with your specific MAC to ensure accurate and up-to-date information.

In summary, to determine if CPT code 49465 is reimbursed by Medicare, you should consult the MPFS and reach out to your MAC for confirmation.

Are You Being Underpaid for 49465 CPT Code?

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