CPT code 74250 is for an X-ray exam of the small intestine using one contrast medium, helping diagnose gastrointestinal issues.
CPT code 74250 is used to describe a specific type of X-ray procedure that examines the small intestine. This procedure involves the use of a single contrast medium, which helps to enhance the visibility of the small intestine on the X-ray images. The term "standard" indicates that this is a routine or typical method for conducting such an examination. This code is typically used by healthcare providers to document and bill for this particular diagnostic imaging service.
For the CPT codes provided, the use of modifiers may be necessary depending on the specific circumstances of the procedure and the billing requirements. Below is a list of potential modifiers that could be applied to these codes:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. It indicates that the provider performed only the interpretation of the x-ray, not the technical component.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It indicates that the provider performed only the technical aspect of the x-ray, such as the use of equipment and supplies.
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 procedures are performed and need to be billed separately.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
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 91 (Repeat Clinical Diagnostic Laboratory Test): Although typically used for laboratory tests, this modifier may be applicable if the x-ray is repeated for clinical reasons.
The necessity of these modifiers depends on the specific billing scenario and payer requirements. It's important to verify with the specific payer guidelines to ensure correct usage.
Determining whether CPT code 74250 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated reimbursement rates. Each MAC may have specific local coverage determinations (LCDs) that can affect whether a particular service, such as CPT code 74250, is reimbursed.
To ascertain if CPT code 74250 is reimbursed, healthcare providers should first verify its inclusion in the MPFS. If it is listed, the next step is to check with the local MAC to ensure there are no additional coverage restrictions or requirements.
It's important to note that even if a service is listed in the MPFS, reimbursement can be influenced by factors such as medical necessity, documentation, and adherence to any specific guidelines outlined by the MAC.
In summary, while the MPFS is a starting point for determining Medicare reimbursement for CPT code 74250, consulting the MAC for your region is crucial to ensure compliance with any local coverage policies.
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 specific codes like 74250. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and ensure you're receiving the full reimbursement you deserve.
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