CPT code 75556 is for a cardiac MRI with flow mapping, a non-invasive imaging test to assess heart structure and blood flow dynamics.
CPT code 75556 is used for a cardiac MRI with flow mapping. This procedure involves using magnetic resonance imaging (MRI) technology to create detailed images of the heart and assess blood flow through the heart's chambers and major vessels. The flow mapping component specifically measures the velocity and direction of blood flow, which can help healthcare providers evaluate heart function and detect any abnormalities or blockages. This code is typically used when a comprehensive evaluation of cardiac structure and blood flow is necessary for diagnosis or treatment planning.
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 MRI results, not the technical component of performing the MRI.
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 the equipment and the technician's time, not the interpretation of the results.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the cardiac MRI is performed in conjunction with another procedure that is not typically reported together. It indicates that the procedures are distinct and separate.
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 91 (Repeat Clinical Diagnostic Laboratory Test): Although not typically used for imaging services, if a repeat test is performed for clinical reasons, this modifier might be applicable to indicate that the test was repeated for a valid medical reason.
7. 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 provided.
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. It indicates that the procedure was started but not completed.
9. Modifier 22 (Increased Procedural Services): This modifier is used 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.
10. Modifier 63 (Procedure Performed on Infants less than 4 kg): This modifier is used when procedures are performed on neonates or infants up to a present body weight of 4 kg to indicate the increased complexity of the procedure due to the patient's size.
The CPT code 75556 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors.
The Medicare Physician Fee Schedule (MPFS) provides a standardized payment structure for services covered under Medicare Part B, including those represented by CPT codes like 75556.
However, the actual reimbursement amount can differ depending on the geographical location and the specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your area.
Each MAC may have its own guidelines and fee schedules, which can influence the final reimbursement rate for CPT code 75556.
It is advisable for healthcare providers to consult the MPFS and their respective MAC for the most accurate and up-to-date reimbursement information.
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