CPT code 76490 is for imaging guidance used during tissue ablation procedures, ensuring precise targeting and treatment of affected areas.
CPT code 76490 is used for tissue ablation procedures. This code specifically refers to the imaging guidance that is utilized during the ablation process. Tissue ablation is a medical procedure where targeted tissue, often tumors or other abnormal growths, is destroyed using various techniques such as radiofrequency, microwave, or cryoablation. The imaging guidance, which could involve ultrasound, CT, or MRI, helps ensure precision in targeting the tissue, enhancing the effectiveness and safety of the procedure. This code is essential for billing purposes, as it accounts for the imaging component of the ablation treatment.
When considering whether a CPT code requires modifiers, it's important to evaluate the specific circumstances of the procedure and the payer's guidelines. 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, such as the interpretation of the imaging study.
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 equipment and technician services.
3. 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.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a laboratory test is repeated on the same day to obtain subsequent test results.
9. Modifier XE - Separate Encounter: This modifier is used to indicate a service that is distinct because it occurred during a separate encounter.
10. Modifier XS - Separate Structure: This modifier is used to indicate a service that is distinct because it was performed on a separate organ/structure.
11. Modifier XP - Separate Practitioner: This modifier is used to indicate a service that is distinct because it was performed by a different practitioner.
12. Modifier XU - Unusual Non-Overlapping Service: This modifier is used to indicate a service that is distinct because it does not overlap usual components of the main service.
Each modifier serves a specific purpose and should be used in accordance with the specific circumstances of the service provided and payer requirements. Always verify with the payer for any specific guidelines or additional modifiers that may be applicable.
CPT code 76490 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 comprehensive listing of fees used to reimburse physicians and other providers/suppliers under Medicare. However, each MAC has the authority to determine coverage and reimbursement specifics for their jurisdiction, which can lead to variations in how CPT code 76490 is reimbursed.
It is essential for healthcare providers to verify with their local MAC to understand the specific reimbursement policies and any potential requirements or limitations associated with this code.
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