CPT CODES

CPT Code 74291

CPT code 74291 is for a contrast x-ray procedure of the gallbladder, used to visualize and assess gallbladder health and function.

Table of Contents
What is CPT Code 74291
Does CPT 74291 Need a Modifier?
CPT Code 74291 Medicare Reimbursement
Are You Being Underpaid for 74291 CPT Code?
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What is CPT Code 74291

CPT code 74291 is used for a diagnostic procedure involving contrast x-rays of the gallbladder. This code specifically refers to a radiological examination where a contrast medium is introduced to enhance the visibility of the gallbladder on x-ray images. This procedure helps healthcare providers assess the structure and function of the gallbladder, identify any abnormalities, and make informed decisions regarding diagnosis and treatment.

Does CPT 74291 Need a Modifier?

For the CPT codes related to contrast x-rays of the gallbladder, the following modifiers may be applicable depending on the specific circumstances of the procedure:

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 is billing for 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 is billing for the use of equipment and supplies necessary to perform the x-ray, excluding the professional interpretation.

3. Modifier 59 - Distinct Procedural Service: This modifier may be used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to prevent bundling of services that are typically considered part of a larger procedure.

4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is repeated by the same physician on the same day. It indicates that the procedure was necessary to be repeated for the patient's care.

5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It helps in differentiating the services provided by different practitioners.

6. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the full service was not performed.

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 applicable when the work required to provide a service is substantially greater than typically required. It indicates that the procedure was more complex or took more time than usual.

Each modifier should be applied based on the specific details of the service provided and the billing requirements of the payer. Proper documentation is essential to support the use of any modifier.

CPT Code 74291 Medicare Reimbursement

The CPT code 74291 is subject to reimbursement considerations under Medicare, but whether it is reimbursed can depend on several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) in your region.

The MPFS provides a list of services and their corresponding reimbursement rates, which are updated annually. However, MACs have the authority to make local coverage determinations that can affect whether a particular service, such as that represented by CPT code 74291, is reimbursed.

Therefore, it is essential for healthcare providers to consult the MPFS for the current year and check with their regional MAC to determine the specific reimbursement status and any applicable coverage criteria for CPT code 74291.

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