CPT code 74248 is for a specialized X-ray procedure that examines the small intestine using fluoroscopy to provide detailed imaging.
CPT code 74248 is used to describe a specific type of X-ray procedure known as a "small intestine follow-through study." This diagnostic imaging test involves taking a series of X-ray images of the small intestine after a patient ingests a contrast material, typically barium. The purpose of this procedure is to visualize the small intestine's structure and function, helping healthcare providers diagnose conditions such as blockages, Crohn's disease, or other abnormalities. The "follow-through" aspect refers to the tracking of the contrast material as it moves through the small intestine, providing detailed images over time.
When considering whether CPT codes 74247 and 74248 require any modifiers, it's important to understand the context of the service provided and the specific circumstances that might necessitate a modifier. 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. It is applicable if the physician is only interpreting the X-ray 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 facility is billing for the use of equipment and supplies, but not the physician's interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier may be necessary if the procedure is distinct or independent from other services performed on the same day. It is used to indicate that the procedure should not be considered a component of another service.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is repeated by the same physician on the same day. It indicates that the repeat procedure was necessary.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the same procedure is repeated by a different physician on the same day. It indicates that the repeat procedure was necessary.
6. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure: This modifier is used if the procedure was started but 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 if the work required to provide the service is substantially greater than typically required.
Each of these modifiers serves a specific purpose and should be used according to the specific details of the service provided and the billing requirements of the payer. Proper use of modifiers ensures accurate billing and reimbursement for services rendered.
To determine if CPT code 74248 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. Each MAC, which administers Medicare claims for a specific geographic area, may have additional local coverage determinations that affect reimbursement.
For CPT code 74248, you would first check the MPFS to see if it is listed and whether it has an assigned reimbursement rate. If it is included in the MPFS, this indicates that Medicare does recognize the code for reimbursement purposes. However, the actual reimbursement can vary based on geographic adjustments and any specific policies set forth by the MAC in your area.
Therefore, to confirm if CPT code 74248 is reimbursed by Medicare, healthcare providers should verify its status on the MPFS and consult their regional MAC for any additional coverage details or requirements.
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