CPT code 67221 is a medical billing code for ocular photodynamic therapy.
CPT code 67221 is designated for ocular photodynamic therapy (PDT) with verteporfin, a treatment primarily used for certain eye conditions like age-related macular degeneration. This code is used to bill for the procedure involving the administration of a light-activated drug, which is then activated with a specific type of light to treat abnormal blood vessels in the eye.
For CPT code 67221, which is used for ocular photodynamic therapy (PDT), certain modifiers may be applicable depending on the specific circumstances of the treatment provided. Here’s an ordered list of potential modifiers and the reasons for their use:
1. -LT (Left side): Indicates that the service was performed on the left eye.
2. -RT (Right side): Indicates that the service was performed on the right eye.
3. -50 (Bilateral procedure): Used when the procedure is performed on both eyes during the same operative session.
4. -26 (Professional component): This modifier is used when only the professional component of the service (i.e., the supervision and interpretation by the physician) is being billed, and not the technical component.
5. -TC (Technical component): Used when only the technical component of the service (i.e., the equipment or supplies) is being billed, separate from the professional component.
6. -59 (Distinct procedural service): Indicates that the procedure was distinct or independent from other services performed on the same day.
7. -79 (Unrelated procedure or service by the same physician during the postoperative period): This modifier is used if the PDT is performed during the postoperative period of another unrelated procedure and is not covered by the global surgery payment for the initial procedure.
Each of these modifiers serves to provide additional details about how the procedure was performed, which can affect billing and reimbursement processes. It’s important for healthcare providers to accurately apply these modifiers to ensure proper claims processing and compliance with payer requirements.
CPT code 67221, which pertains to ocular photodynamic therapy (specifically with verteporfin), is generally reimbursed by Medicare. However, the reimbursement can vary based on the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., outpatient hospital, physician's office), and other factors such as the local coverage determinations (LCDs).
As for the reimbursement amount, it is subject to change annually based on the Medicare Physician Fee Schedule (MPFS) and other regulatory updates. Providers should check the latest MPFS database or contact their local MAC for the most current and accurate reimbursement information for CPT code 67221. Additionally, it's important to ensure that all necessary documentation and indications for the therapy are met to secure reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to analyze contracts and identify discrepancies down to specific CPT codes, such as 67221 for ocular photodynamic therapy, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every service rendered.
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