CPT code 76000 is used for a fluoroscopy procedure lasting less than one hour, performed by a physician or qualified healthcare professional.
CPT code 76000 is used to describe a medical procedure involving fluoroscopy that lasts less than one hour and is performed by a physician or qualified healthcare professional. Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the interior of the body, often used to guide diagnostic and therapeutic procedures. This code is typically used when the fluoroscopy is not bundled with another procedure and is billed separately.
When considering whether a CPT code requires any modifiers, it's essential to understand the context of the procedure and the specific circumstances under which it was performed. Here is a list of potential modifiers that could be applicable:
1. Modifier 26 (Professional Component): This modifier is used when the service provided is the professional component only, such as the interpretation of the fluoroscopy, without the technical component.
2. Modifier TC (Technical Component): This modifier is used when the service provided is the technical component only, such as the use of the fluoroscopy equipment, without the professional 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 procedures are performed and need to be reported separately.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician on the same day.
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.
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 started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required.
9. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same session by the same provider.
10. Modifier 62 (Two Surgeons): This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
11. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required during the procedure.
The use of these modifiers depends on the specific circumstances of the procedure and the billing requirements of the payer. It is crucial to ensure accurate documentation and justification for any modifiers applied to a CPT code.
The CPT code 76000, which involves fluoroscopy services, is subject to reimbursement by Medicare, but this depends 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 comprehensive list of fees that Medicare will pay for each service, and it is updated annually to reflect changes in healthcare costs and practices.
Each MAC, which administers Medicare claims for a specific geographic area, may have additional guidelines or requirements for reimbursement.
Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 76000 with their local MAC and consult the most recent MPFS to ensure compliance and accurate billing.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments at the CPT code level, including specific codes like 76000. With RevFind, you can pinpoint discrepancies by individual payer, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your financial outcomes.
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