CPT code 76083 is an add-on for computer-aided detection with mammograms, enhancing image analysis to assist radiologists in identifying abnormalities.
CPT code 76083 is an add-on code used to describe the computer-aided detection (CAD) process that is performed in conjunction with a mammogram. This code is specifically used when a computer system is employed to analyze mammographic images for the purpose of identifying potential abnormalities that may require further investigation. It is important to note that this code is used in addition to the primary mammography procedure code, as it represents the supplementary use of technology to enhance the radiologist's ability to detect breast cancer or other issues.
For CPT codes 76082 and 76083, which are related to computer mammogram add-ons, the use of modifiers may be necessary to provide additional information about the service provided. Here is a list of potential modifiers that could be used with these codes:
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 mammogram, not the technical component.
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 equipment and supplies necessary to perform the mammogram, excluding the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the computer mammogram add-on is performed as a distinct service from other procedures on the same day. It helps to indicate that the service is separate and should not be bundled with other services.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the computer mammogram add-on is repeated on the same day by the same provider. It indicates that the procedure was necessary to be repeated for valid clinical reasons.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the procedure is repeated on the same day by a different provider. It signifies that the repeat procedure was necessary and performed by another physician.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although less common for imaging, this modifier could be used if the mammogram add-on is repeated for clinical reasons, not due to equipment malfunction or error.
Each of these modifiers serves a specific purpose and should be used in accordance with the clinical scenario and payer requirements to ensure accurate billing and reimbursement.
The CPT code 76083 is subject to reimbursement considerations under Medicare. To determine if this specific code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide guidance on coverage and reimbursement policies specific to your area.
The MACs may have specific local coverage determinations (LCDs) that affect whether CPT code 76083 is reimbursed. Therefore, checking both the MPFS and consulting with your MAC is essential for accurate reimbursement information.
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 CPT code 76083, RevFind offers unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
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
