CPT CODES

CPT Code 67120

CPT code 67120 is a medical procedure code for the removal of eye implant material.

Table of Contents
What is CPT Code 67120
Does CPT 67120 Need a Modifier?
CPT Code 67120 Medicare Reimbursement
Are You Being Underpaid for 67120 CPT Code?
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What is CPT Code 67120

CPT code 67120 is a medical procedure code that describes the surgical removal of an implanted material from the eye. This could involve removing a previously implanted device or other material that is no longer needed or has caused complications. The procedure is typically performed by an ophthalmologist.

Does CPT 67120 Need a Modifier?

For CPT code 67120, which is used for the removal of eye implant material, 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. -RT (Right Side) and -LT (Left Side): These modifiers are used to specify which eye underwent the procedure. Since eye surgeries are specific to each eye, indicating the correct side is crucial for accurate billing and medical records.

2. -50 (Bilateral Procedure): If the procedure involves the removal of implant materials from both eyes during the same operative session, this modifier should be used. It is important to check payer policies as some may require each eye to be billed separately.

3. -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 patient has to return to the operating room for a related procedure that was not planned at the time of the initial surgery.

4. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If the removal of the eye implant material is performed during the postoperative period of a different, unrelated procedure, this modifier would be appropriate.

5. -22 (Increased Procedural Services): If the procedure requires significantly more effort or time than typically required, this modifier can be used to indicate that the procedure was more complex or difficult than usual.

6. -59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is crucial when multiple procedures are performed on the same day but are not normally reported together.

7. -76 (Repeat Procedure by Same Physician): If the procedure to remove the eye implant material needs to be repeated by the same physician, this modifier would be used to indicate the repeat nature of the procedure.

Each of these modifiers serves to provide specific, additional information that affects how the procedure is billed and reimbursed. It is essential to choose the correct modifier(s) based on the specific details of how and why the procedure was performed to ensure accurate and efficient billing.

CPT Code 67120 Medicare Reimbursement

CPT code 67120, which pertains to the removal of eye implant material, is generally reimbursed by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location of the service provider, the setting in which the procedure is performed (such as hospital outpatient department or an ambulatory surgical center), and the Medicare Administrative Contractor (MAC) policies for the region.

To determine the exact reimbursement amount for CPT code 67120, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC. This will provide the most accurate and up-to-date information regarding reimbursement rates for this specific procedure under Medicare. Additionally, it's important to ensure that all documentation and coding are accurately completed to facilitate appropriate reimbursement.

Are You Being Underpaid for 67120 CPT Code?

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