CPT CODES

CPT Code 74712

CPT code 74712 is for an MRI of a single or first fetus during pregnancy, used to assess fetal development and diagnose potential issues.

Table of Contents
What is CPT Code 74712
Does CPT 74712 Need a Modifier?
CPT Code 74712 Medicare Reimbursement
Are You Being Underpaid for 74712 CPT Code?
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What is CPT Code 74712

CPT code 74712 is used to describe an MRI (Magnetic Resonance Imaging) procedure specifically for a fetus in a single or first gestation. This code is utilized when a healthcare provider performs an MRI to obtain detailed images of a fetus during pregnancy, typically to assess fetal development or diagnose potential abnormalities. The procedure is non-invasive and provides high-resolution images, which can be crucial for making informed medical decisions regarding the health of the fetus.

Does CPT 74712 Need a Modifier?

When considering whether a CPT code requires modifiers, it's important to understand the context of the service provided, as modifiers can indicate specific circumstances that affect billing and reimbursement. Below is a list of potential modifiers that could be applicable to the codes provided:

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 provider is only interpreting the results of the imaging study.

2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It applies if the provider is responsible for the equipment and technical staff but not the interpretation.

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 imaging services are provided and need to be distinguished from one another.

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 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used when a related procedure during the postoperative period requires a return to the operating room or procedure room.

7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.

8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although more commonly used for lab tests, this modifier can sometimes be relevant if a diagnostic test is repeated for clinical reasons.

9. Modifier XE - Separate Encounter: This modifier is used to indicate that a service is distinct because it occurred during a separate encounter.

10. Modifier XS - Separate Structure: This modifier is used to indicate that a service is distinct because it was performed on a separate organ/structure.

11. Modifier XP - Separate Practitioner: This modifier is used to indicate that a service is distinct because it was performed by a different practitioner.

12. Modifier XU - Unusual Non-Overlapping Service: This modifier is used to indicate that a service is distinct because it does not overlap usual components of the main service.

The application of these modifiers depends on the specific circumstances of the service provided, and it's crucial to ensure accurate documentation and coding to support the use of any modifier. Always refer to the latest coding guidelines and payer-specific policies for the most accurate and compliant billing practices.

CPT Code 74712 Medicare Reimbursement

The CPT code 74712 is subject to reimbursement considerations under Medicare, but whether it is reimbursed can depend on several factors.

The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining the reimbursement rates for specific CPT codes, including 74712. The MPFS outlines the payment amounts that Medicare will provide for services rendered by physicians and other healthcare providers.

However, it's important to note that the reimbursement for CPT code 74712 can also be influenced by the policies of the Medicare Administrative Contractor (MAC) in your specific region. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that can affect whether a particular service is covered and reimbursed.

Therefore, to determine if CPT code 74712 is reimbursed by Medicare, healthcare providers should consult both the MPFS for the national reimbursement rate and their regional MAC for any specific coverage guidelines or restrictions that may apply.

Are You Being Underpaid for 74712 CPT Code?

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