CPT code 76394 is for MRI-guided focused ultrasound used in tissue ablation, a non-invasive procedure to destroy targeted tissue areas.
CPT code 76394 is used for an MRI procedure specifically designed for tissue ablation. This code represents the use of magnetic resonance imaging to guide and monitor the process of ablating, or destroying, targeted tissue within the body. Tissue ablation can be used for various medical purposes, such as treating tumors or other abnormal growths. The MRI provides detailed images that help healthcare providers accurately target the tissue that needs to be ablated, ensuring precision and effectiveness in the treatment.
For the CPT code related to "Mr guidance for needle place," the following modifiers may be applicable:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed, such as the interpretation of the MRI guidance.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed, such as the use of the MRI equipment and the technician's services.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the MRI guidance is performed as a distinct service from other procedures performed on the same day.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the MRI guidance is repeated by the same physician on the same day.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the MRI guidance is repeated by a different physician on the same day.
For the CPT code related to "Mri for tissue ablation," the following modifiers may be applicable:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed, such as the interpretation of the MRI for tissue ablation.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed, such as the use of the MRI equipment and the technician's services.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the MRI for tissue ablation is performed as a distinct service from other procedures performed on the same day.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the MRI for tissue ablation is repeated by the same physician on the same day.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the MRI for tissue ablation is repeated by a different physician on the same day.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered.
CPT code 76394 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 local Medicare Administrative Contractor (MAC).
The MPFS provides a list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, not all CPT codes are covered or reimbursed at the same rate, and some may not be reimbursed at all if they do not meet specific criteria or if they are considered experimental or investigational.
To determine if CPT code 76394 is reimbursed by Medicare, healthcare providers should consult the MPFS to see if the code is listed and what the reimbursement rate might be. Additionally, it is crucial to check with the local MAC, as they have the authority to make coverage decisions and may have specific guidelines or requirements that affect reimbursement. MACs can vary by region, and their policies can influence whether a particular service is covered under Medicare.
In summary, while CPT code 76394 may be listed in the MPFS, its reimbursement by Medicare is not guaranteed and is subject to the policies of the relevant MAC. Healthcare providers should verify coverage and reimbursement specifics with their local MAC to ensure compliance and proper billing practices.
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