CPT code 76641 is for a comprehensive ultrasound of the breast, providing detailed imaging to assist healthcare providers in diagnosis and treatment planning.
CPT code 76641 is used to describe a comprehensive ultrasound examination of the breast. This procedure involves a detailed evaluation of the breast tissue, including all four quadrants of the breast and the retroareolar region. The purpose of this complete ultrasound is to assess for any abnormalities, such as lumps, cysts, or other changes in the breast tissue that may require further investigation. This code is typically used when a thorough assessment is necessary, often following a physical exam or mammogram that indicated potential concerns.
When considering the use of modifiers for CPT codes 76604 and 76641, it is important to understand the context of the service provided and any specific circumstances that may require the application of modifiers. Below 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. It indicates that the provider is billing for the interpretation of the ultrasound, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and technician services, not the interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the ultrasound is performed in conjunction with another procedure that is not typically reported together, and it is necessary to indicate that the services are distinct and separate.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is repeated by the same physician on the same day. It indicates that the repeat procedure was necessary.
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. It signifies that the repeat procedure was necessary and performed by another provider.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the ultrasound is part of an unplanned return to the procedure room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if the ultrasound is performed during the postoperative period of another procedure but is unrelated to the initial surgery.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for lab tests, this modifier can sometimes be applicable if the ultrasound is repeated for clinical reasons on the same day.
Each modifier serves a specific purpose and should be used in accordance with the guidelines set forth by the American Medical Association and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for services rendered.
CPT code 76641 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a standardized payment structure for services covered under Medicare Part B, including those associated with CPT code 76641. However, the actual reimbursement amount can differ depending on geographic location and other considerations, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and set payment rates within their jurisdiction, which can lead to variations in reimbursement. Therefore, healthcare providers should consult their specific MAC for precise reimbursement details related to CPT code 76641.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 76641. Schedule a demo today to see how RevFind can help you maximize reimbursements from each payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
