CPT code 76145 is used for evaluating radiation exposure by a medical physicist, ensuring safe and effective radiation use in healthcare settings.
CPT code 76145 is used for the medical physics dose evaluation for radiation exposure. This code is typically utilized when a healthcare provider needs to assess and document the amount of radiation a patient has been exposed to during a medical procedure. The evaluation is conducted by a medical physicist who ensures that the radiation dose is within safe and effective limits, optimizing patient safety while achieving the desired diagnostic or therapeutic outcomes. This code is crucial for maintaining compliance with safety standards and for the accurate billing of services related to radiation exposure assessments.
When considering whether CPT codes 76140 and 76145 require any modifiers, it's important to understand the context in which these codes are used and the specific circumstances of the service provided. Here is a list of potential modifiers that could be applicable:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. For example, if a radiologist provides only the interpretation of an X-ray without owning the equipment, this modifier would be applicable.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. This would apply if the service involves the use of equipment and facilities but not the professional interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the service is distinct or independent from other services performed on the same day. It indicates that the procedure is not normally reported together but is appropriate under the circumstances.
4. Modifier 76 (Repeat Procedure by Same Physician): If the same physician repeats the procedure on the same day, this modifier is used to indicate that the service was repeated.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure is repeated on the same day by a different physician.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although more commonly used for lab tests, if applicable, this modifier indicates that a test was repeated for a valid medical reason.
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 99 (Multiple Modifiers): If multiple modifiers are necessary, this modifier indicates that more than one modifier is applicable to the service.
The use of modifiers is contingent upon the specific details of the service provided, and it is crucial to ensure that the documentation supports the use of any modifier to avoid claim denials or audits. Always refer to the latest CPT coding guidelines and payer-specific policies for the most accurate and up-to-date information.
The CPT code 76145 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS).
Whether or not this code is reimbursed by Medicare can depend on several factors, including the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) in your region.
Each MAC may have different coverage determinations and reimbursement rates for CPT code 76145, so it is essential to consult the local MAC's policies and the MPFS for the most accurate and up-to-date information regarding reimbursement eligibility and rates for this specific code.
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