CPT code 70555 is for an fMRI of the brain performed by a physician or psychologist, used to assess brain activity and function.
CPT code 70555 is used to describe a functional magnetic resonance imaging (fMRI) of the brain, which is performed by a physician or psychologist. This procedure involves using advanced imaging technology to measure and map brain activity by detecting changes in blood flow. It is often used to assess brain function, identify areas of the brain responsible for critical functions such as speech and movement, and assist in planning surgeries or treatments for neurological conditions.
For the CPT codes related to fMRI brain procedures, 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 billing is for the interpretation of the fMRI results by a physician or psychologist, rather than 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 billing is for the use of the equipment and the technical staff involved in performing the fMRI, excluding the interpretation.
3. Modifier 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. It may be applicable if multiple procedures are performed and need to be reported separately.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although typically used for laboratory tests, this modifier may be applicable if the fMRI is repeated for clinical diagnostic purposes.
These modifiers help ensure accurate billing and reimbursement by clarifying the specific circumstances under which the fMRI services were provided. It is important to review payer-specific guidelines as they may have additional requirements or restrictions regarding the use of these modifiers.
The CPT code 70555 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse healthcare providers for services rendered, including those associated with CPT code 70555.
However, it's important to note that the reimbursement process can also be influenced by the local coverage determinations made by Medicare Administrative Contractors (MACs).
These contractors have the authority to establish specific coverage policies and payment rates for services within their jurisdictions, which can affect how and when CPT code 70555 is reimbursed.
Therefore, healthcare providers should consult both the MPFS and their respective MACs to ensure compliance and understand the reimbursement specifics for CPT code 70555.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 70555, RevFind provides unparalleled accuracy and insight by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
