CPT code 76645 is for an ultrasound exam of one or both breasts, used by healthcare providers to assess breast tissue for abnormalities.
CPT code 76645 is used to describe an ultrasound examination of the breast(s). This procedure involves using high-frequency sound waves to create images of the breast tissue, which can help in evaluating abnormalities detected during a physical exam or mammography. The ultrasound can be performed on one or both breasts and is typically used to further investigate lumps, cysts, or other changes in breast tissue. This non-invasive diagnostic tool is crucial for providing detailed information that can assist healthcare providers in making informed decisions about patient care.
When dealing with CPT codes for ultrasound breast procedures, it is important to consider the potential need for modifiers to ensure accurate billing and reimbursement. Here is a list of 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 results, 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 the equipment and the performance of the ultrasound, excluding the interpretation.
3. Modifier 50 (Bilateral Procedure): If the ultrasound is performed on both breasts, this modifier is used to indicate that the procedure was bilateral.
4. 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. It may be necessary if multiple procedures are performed that are not typically reported together.
5. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the same procedure is repeated by a different physician on the same day.
7. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier is used if the patient returns to the procedure room for a related procedure during the postoperative period.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician): This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period.
These modifiers help clarify the specifics of the service provided and ensure proper billing and reimbursement processes are followed. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 76645 is indeed reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided to Medicare beneficiaries, and CPT 76645 is listed among those services. However, it's important to note that reimbursement can vary based on several factors, including geographic location and specific contractual agreements. These variations are managed by Medicare Administrative Contractors (MACs), which are responsible for processing claims and determining local coverage decisions. Therefore, while CPT 76645 is generally reimbursed under the MPFS, healthcare providers should verify specific reimbursement details with their respective MAC to ensure accurate billing and payment.
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