CPT Code 66990
CPT code 66990 is used for billing the use of an ophthalmic endoscope during surgery.
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What is CPT Code 66990
CPT code 66990 is used to denote the use of an ophthalmic endoscope during a surgical procedure. This code is an add-on, meaning it is billed in conjunction with the primary surgery code when an endoscope is utilized to enhance visualization during the procedure. It is specifically applicable to eye surgeries where an endoscope provides a necessary visual aid to the surgeon.
Does CPT 66990 Need a Modifier?
For CPT code 66990, which is used for ophthalmic endoscopic procedures, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is an ordered list of potential modifiers and the reasons for their use:
1. -22 (Increased Procedural Services): This modifier is used when the service provided is significantly greater than typically required. It can be applied if the procedure involves extra work due to unusual anatomy or complications.
2. -51 (Multiple Procedures): Use this modifier when this procedure is performed at the same session as other procedures. It indicates that multiple procedures were performed on the same day.
3. -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. This can include different sessions, different procedures, different sites, or separate incisions/excisions.
4. -76 (Repeat Procedure by Same Physician): This modifier should be used if the same physician needs to repeat the ophthalmic endoscopic procedure in the same session.
5. -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 a return to the operating room is required to address a complication from the initial procedure.
6. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Use this modifier if a new procedure, which is not related to the initial procedure, is performed during the postoperative period.
7. -RT (Right Side) and -LT (Left Side): These modifiers are used to specify which eye the procedure was performed on. This is crucial for clarity in billing and medical records.
8. -50 (Bilateral Procedure): If the procedure is performed on both eyes during the same session, this modifier should be used.
Each of these modifiers serves to provide additional details that can affect reimbursement and are essential for accurate medical billing and compliance with insurance requirements.
CPT Code 66990 Medicare Reimbursement
CPT code 66990, which refers to the use of an ophthalmic endoscope during a surgical procedure, is reimbursable by Medicare. The reimbursement for this code can vary based on geographic location and the setting in which the procedure is performed (e.g., hospital outpatient department vs. ambulatory surgical center). To determine the specific reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through your regional Medicare administrator. This will provide the most accurate and up-to-date information regarding the reimbursement rate for CPT code 66990 in your specific area.
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