CPT code 76092 is used for a routine mammogram screening, a preventive test to detect breast cancer early in women without symptoms.
CPT code 76092 is used to describe a screening mammogram for women. This procedure involves taking X-ray images of the breasts to detect any signs of breast cancer or other abnormalities at an early stage. The screening is typically performed on women who do not have any symptoms or signs of breast disease, as part of routine preventive healthcare. The goal is to identify potential issues before they develop into more serious conditions, allowing for early intervention and treatment.
When considering the use of modifiers for CPT codes related to mammograms, it's important to ensure accurate billing and compliance with payer requirements. Here is a list of potential modifiers that could be applicable:
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 indicates that the service provided was the interpretation of the mammogram.
2. Modifier TC (Technical Component): This modifier is used when the technical component of the service is being billed separately. It indicates that the service provided was the performance of the mammogram, including the use of equipment and supplies.
3. Modifier 52 (Reduced Services): This modifier may be used if the mammogram service was partially reduced or eliminated at the discretion of the healthcare provider. It indicates that the service provided was less than what is typically required.
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 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 used to prevent bundling of services that are typically considered inclusive.
7. Modifier GG (Performance and Payment of a Screening Mammogram and Diagnostic Mammogram on the Same Patient, Same Day): This modifier is used when both a screening and diagnostic mammogram are performed on the same patient on the same day.
8. Modifier GH (Diagnostic Mammogram Converted from Screening Mammogram on Same Day): This modifier is used when a screening mammogram is converted to a diagnostic mammogram on the same day due to findings that require further investigation.
Each modifier serves a specific purpose and should be used in accordance with payer guidelines and the specific circumstances of the service provided. Proper use of modifiers ensures accurate billing and reimbursement for mammogram services.
The CPT code 76092 is not reimbursed by Medicare. This is because it has been replaced by other codes that align with current screening guidelines.
When considering reimbursement, it's important to refer to the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information.
The MACs are responsible for processing Medicare claims and can provide specific guidance on which CPT codes are covered and reimbursed under Medicare policies.
Always ensure that you are using the most current CPT codes to avoid claim denials and ensure proper reimbursement.
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