CPT code 73020 is for an X-ray exam of the shoulder, detailing the procedure for diagnostic imaging to assess shoulder conditions.
CPT code 73020 is used to describe an X-ray examination of the shoulder. This code is specifically for a radiological procedure that involves taking images of the shoulder joint to help diagnose conditions such as fractures, dislocations, or other abnormalities. The X-ray provides detailed images that assist healthcare providers in assessing the bone structure and alignment of the shoulder.
When considering whether CPT codes 73010 and 73020 require any modifiers, it's important to understand the context of the service provided and the specific circumstances of the patient encounter. Here is a list of potential modifiers that could be applied to these codes, along with the reasons for their use:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the X-ray service is being billed. This typically applies when the radiologist interprets the X-ray, but the technical component (the actual taking of the X-ray) is performed by another entity.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the X-ray service is being billed. This applies when the facility provides the equipment and technician to perform the X-ray, but the interpretation is done by a separate provider.
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 necessary if multiple imaging services are provided and need to be distinguished from one another.
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 or service.
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 or service.
6. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier is used if the patient requires 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): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
8. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for lab tests, this modifier can sometimes be relevant if the X-ray is repeated for clinical reasons.
The necessity of these modifiers depends on the specific circumstances of the service provided, and it is crucial to ensure accurate documentation and justification for their use to avoid claim denials or audits. Always verify payer-specific guidelines, as requirements for modifiers can vary.
The CPT code 73020 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided to Medicare beneficiaries, and CPT code 73020 is listed among those services.
However, the reimbursement rate can vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) responsible for your region. MACs are private organizations that contract with Medicare to process claims and determine local coverage decisions, which can influence the final reimbursement amount for CPT code 73020.
Healthcare providers should consult their specific MAC for detailed information on reimbursement rates and any additional requirements that may apply.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including 73020, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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
