CPT code 76380 is for a CT scan follow-up study, used to evaluate changes in a patient's condition by comparing with previous imaging results.
CPT code 76380 is used for a follow-up computed tomography (CT) scan, often referred to as a CAT scan. This code is specifically applied when a limited or focused CT study is performed to monitor a specific condition or area of concern that has been previously identified. Unlike a comprehensive CT scan, which might cover a broader area or multiple regions, this follow-up study is more targeted, allowing healthcare providers to assess changes or progress in a particular area of interest. This can be crucial for evaluating the effectiveness of treatment or monitoring the progression of a disease.
1. -26 (Professional Component): This modifier is used when only the professional component of the CT scan follow-up study is being billed. It indicates that the provider is billing for the interpretation and report of the scan.
2. -TC (Technical Component): This modifier is used when only the technical component of the CT scan follow-up study is being billed. It indicates that the provider is billing for the use of equipment and supplies necessary to perform the scan.
3. -59 (Distinct Procedural Service): This modifier may be used if the CT scan follow-up study is performed as a distinct service from other procedures performed on the same day. It helps to indicate that the service is separate and not a component of another procedure.
4. -76 (Repeat Procedure by Same Physician): This modifier is applicable if the CT scan follow-up study is repeated on the same day by the same provider. It indicates that the procedure was necessary to be performed more than once.
5. -77 (Repeat Procedure by Another Physician): This modifier is used when the CT scan follow-up study is repeated on the same day by a different provider. It signifies that the procedure was necessary to be performed again by another physician.
The CPT code 76380 is subject to reimbursement considerations under Medicare, but whether it is reimbursed can depend 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 list of services covered by Medicare and their respective reimbursement rates, but local MACs have the authority to determine coverage specifics and any additional requirements for reimbursement.
Therefore, it is essential for healthcare providers to verify with their local MAC to ensure that CPT code 76380 is covered and to understand any documentation or medical necessity criteria that must be met for reimbursement.
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