CPT code 76012 is for fluoroscopic guidance during percutaneous vertebroplasty, a procedure to stabilize spinal fractures.
CPT code 76012 is used to describe the fluoroscopic guidance necessary for a percutaneous vertebroplasty procedure. In simpler terms, this code is for the imaging technique that helps doctors see inside the body while they are performing a vertebroplasty, which is a minimally invasive procedure used to stabilize a fractured vertebra in the spine. The fluoroscopy provides real-time X-ray images, allowing the healthcare provider to accurately guide the instruments and ensure the bone cement is placed correctly in the vertebra.
1. Modifier 26 (Professional Component): This modifier is used when the professional component of the service is being billed separately from the technical component. It is applicable when a physician interprets the X-ray or fluoroscopy images but does not own the equipment.
2. Modifier TC (Technical Component): This modifier is used when the technical component of the service is being billed separately. It applies when the facility provides the equipment and technician services but not the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the procedure is performed in conjunction with another procedure that is not typically reported together, to indicate that the services 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.
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.
6. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier is applicable if the patient returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of a different procedure.
8. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can sometimes be applicable if the procedure 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.
CPT code 76012, which involves fluoroscopic guidance, is subject to reimbursement considerations under Medicare. To determine if CPT code 76012 is reimbursed by Medicare, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, reimbursement can vary based on the policies of the specific Medicare Administrative Contractor (MAC) that processes claims in a provider's geographic region. Each MAC may have different local coverage determinations (LCDs) that affect whether a particular service, such as CPT code 76012, is reimbursed.
Therefore, it is essential for providers to verify the reimbursement status of CPT code 76012 with their respective MAC and review the MPFS for the most accurate and up-to-date information.
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