CPT code 75571 is a heart CT scan without dye, including a calcium score test, used to assess heart health and detect potential coronary artery disease.
CPT code 75571 is for a computed tomography (CT) scan of the heart performed without the use of contrast dye, which includes a calcium scoring test. This procedure is typically used to assess the presence of calcium deposits in the coronary arteries, which can be an indicator of coronary artery disease. The absence of contrast dye means that the scan is non-invasive and focuses specifically on detecting calcifications that may suggest the risk of heart disease.
For the CPT codes provided, here is a list of potential modifiers that could be applicable, along with the reasons for their use:
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 healthcare provider is only interpreting the results of the procedure 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 provider is responsible for the equipment, supplies, and technical staff involved in the procedure.
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 is applicable if the procedure is not typically reported together with another procedure but is appropriate under the circumstances.
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 91 (Repeat Clinical Diagnostic Laboratory Test): This modifier is used for repeat laboratory tests performed on the same day to obtain subsequent (multiple) test results.
7. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
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.
9. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required.
These modifiers are used to provide additional information about the service provided and ensure accurate billing and reimbursement. It is important to review the specific circumstances of each procedure to determine the appropriate modifier(s) to apply.
To determine if the CPT code 75571 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) specific to your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis.
Each MAC, which administers Medicare benefits in different regions, may have specific coverage policies and reimbursement rates for CPT code 75571.
Therefore, it is crucial to verify with the relevant MAC to ensure that this particular code is covered and to understand any specific billing requirements or limitations that may apply.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 75571, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
