CPT code 76814 is an add-on for an ultrasound measuring the nuchal translucency in obstetric care, providing additional insights during pregnancy.
CPT code 76814 is an add-on code used in obstetric ultrasound procedures. It specifically refers to the measurement of the nuchal translucency, which is a collection of fluid at the back of a fetus's neck. This measurement is typically performed during the first trimester of pregnancy and is used as part of screening for chromosomal abnormalities, such as Down syndrome. As an add-on code, it is used in conjunction with a primary ultrasound procedure code to indicate that this additional measurement was performed.
When considering the use of CPT codes 76813 and 76814, it's important to understand 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 is applicable if the healthcare provider is only interpreting the ultrasound and not providing the equipment or technical component.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It applies if the provider is supplying the equipment and performing the ultrasound, but not interpreting the results.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the ultrasound is performed in conjunction with other procedures that are not typically reported together, to indicate that the services are distinct and separate.
4. Modifier 76 (Repeat Procedure by Same Physician): If the same provider performs the nuchal translucency measurement more than once on the same day, this modifier can be used to indicate that the procedure was repeated.
5. Modifier 77 (Repeat Procedure by Another Physician): If a different provider repeats the nuchal translucency measurement on the same day, this modifier is appropriate.
6. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same session. It helps to indicate that more than one procedure was performed and may be necessary if the nuchal translucency measurement is part of a series of ultrasounds.
7. Modifier 22 (Increased Procedural Services): If the procedure required significantly more work than usual, this modifier can be used to indicate the increased complexity or time involved.
These modifiers help clarify the nature of the services provided and ensure that the billing accurately reflects the work performed. It's crucial to apply the correct modifiers to avoid claim denials and ensure proper reimbursement.
CPT code 76814 is subject to reimbursement considerations under the Medicare Physician Fee Schedule (MPFS). Whether or not this specific code is reimbursed by Medicare can depend on several factors, including the local coverage determinations made by the Medicare Administrative Contractor (MAC) in your region.
MACs are responsible for interpreting national policies and creating guidelines that determine the reimbursement eligibility for specific CPT codes like 76814. Therefore, it is essential for healthcare providers to consult the relevant MAC for their jurisdiction to understand the specific reimbursement policies and any documentation requirements that may apply to CPT code 76814.
Additionally, providers should ensure that the services billed under this code meet the medical necessity criteria as outlined by Medicare.
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