CPT code 73501 is for a single-view X-ray exam of one hip, used by healthcare providers to document and categorize this specific diagnostic service.
CPT code 73501 is used to describe a medical billing code for an X-ray examination of a single hip, capturing just one view. This code is utilized by healthcare providers to document and bill for the imaging service when a limited examination of the hip is required, typically to assess for fractures, dislocations, or other abnormalities in the hip joint.
When considering whether CPT codes 73500 and 73501 require any modifiers, it's important to understand the context in which these codes are used and the specific circumstances of the service provided. Here is a list of potential modifiers that could be applicable:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. For example, if a radiologist is interpreting the X-ray but not providing the technical component (e.g., the equipment and technician services), this modifier would be appropriate.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. This would apply if the facility is providing the equipment and technician services but not the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the X-ray exam is performed in conjunction with another procedure that is not typically reported together, and it is essential to indicate that the services are distinct and separate.
4. Modifier 76 (Repeat Procedure by Same Physician): If the X-ray exam needs to be repeated on the same day by the same physician or healthcare provider, this modifier would be used to indicate that the repeat procedure was necessary.
5. Modifier 77 (Repeat Procedure by Another Physician): Similar to Modifier 76, this is used when the repeat procedure is performed by a different physician or healthcare provider on the same day.
6. Modifier 52 (Reduced Services): If the service provided was less than what is typically required for the procedure, this modifier can be used to indicate that the service was reduced.
7. Modifier 53 (Discontinued Procedure): If the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier would be appropriate.
8. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): While not typically used for X-ray exams, if a repeat test is necessary for clinical reasons, this modifier could be applicable in specific scenarios.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the service provided. It's crucial to assess each situation individually to determine the appropriate use of modifiers.
The CPT code 73501 is indeed reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services and procedures covered by Medicare, and CPT code 73501 is listed among those eligible for reimbursement.
However, the specific reimbursement amount can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting the payment rates within their jurisdiction, so healthcare providers should consult their respective MAC for precise reimbursement details for CPT code 73501.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments at the CPT code level, including specific codes like 73501. Schedule a demo today to see how RevFind can pinpoint discrepancies by individual payer, ensuring you receive the full reimbursement you deserve.
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