CPT code 73200 is for a CT scan of the upper extremity performed without contrast dye, used for diagnostic imaging of arms or shoulders.
CPT code 73200 is used to describe a computed tomography (CT) scan of the upper extremity, such as the arm or shoulder, performed without the use of contrast dye. This imaging procedure provides detailed cross-sectional images of the bones, muscles, and other tissues in the upper extremity, helping healthcare providers diagnose conditions or injuries without the need for contrast material to enhance the images.
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. It is applicable if the healthcare provider is only interpreting the X-ray or CT scan and not providing the technical component.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It applies if the healthcare provider is responsible for the equipment, supplies, and technical staff involved in performing the X-ray or CT scan.
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 the X-ray or CT scan is performed in conjunction with other procedures that are not typically reported together.
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 another physician or qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 (Discontinued Procedure): This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required.
9. Modifier 23 (Unusual Anesthesia): This modifier is used when a procedure that usually requires no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.
10. Modifier 99 (Multiple Modifiers): This modifier is used when two or more modifiers are necessary to describe the service provided accurately.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered.
The CPT code 73200, which is associated with a specific medical procedure, is generally reimbursed by Medicare, provided that the procedure is deemed medically necessary and meets all coverage criteria.
Reimbursement rates for this code can be found in the Medicare Physician Fee Schedule (MPFS), which outlines the payment amounts for services covered under Medicare Part B.
However, it's important to note that the reimbursement and coverage specifics can vary depending on the region and the local policies set by the Medicare Administrative Contractor (MAC) responsible for that area.
Each MAC has the authority to establish Local Coverage Determinations (LCDs) that may affect whether and how a particular service is reimbursed.
Therefore, healthcare providers should consult the MPFS and their respective MAC's guidelines to ensure compliance and accurate billing for CPT code 73200.
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