CPT code 74150 is for a CT scan of the abdomen performed without contrast dye, used to diagnose or monitor abdominal conditions.
CPT code 74150 is used to describe a computed tomography (CT) scan of the abdomen performed without the use of contrast dye. This diagnostic imaging procedure captures detailed cross-sectional images of the abdominal area, helping healthcare providers assess and diagnose various conditions such as abdominal pain, kidney stones, or tumors. The absence of contrast dye means that the scan is conducted without the injection or ingestion of a substance that enhances the visibility of certain structures or abnormalities within the abdomen.
When considering the use of modifiers for the CPT codes provided, it's important to understand the context of the service provided, as modifiers can be used to indicate specific circumstances that affect the service. Below 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 service is being billed. This is applicable if the healthcare provider is only interpreting the results of the imaging study, 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. This applies if the healthcare provider is responsible for the equipment and technical staff, but not the interpretation of the results.
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 is 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 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 other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can sometimes be relevant if the imaging is part of a diagnostic series that needs to be repeated for clinical reasons.
7. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
8. 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.
9. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required.
The application of these modifiers depends on the specific circumstances of the service provided, and it is crucial to ensure that the use of any modifier is supported by appropriate documentation in the patient's medical record.
CPT code 74150, which refers to a specific medical procedure, is generally reimbursed by Medicare, provided that the service is deemed medically necessary and meets all applicable coverage criteria.
The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
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 local coverage determinations, which can influence whether and how much Medicare reimburses for CPT code 74150 in different regions.
Healthcare providers should verify with their respective MAC to ensure compliance with local policies and to obtain accurate reimbursement information.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including 74150, RevFind provides unparalleled insights by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
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
