CPT code 76819 is for a fetal biophysical profile without a non-stress test, assessing fetal health through ultrasound measurements.
CPT code 76819 is used for a fetal biophysical profile without a non-stress test (NST). This procedure involves an ultrasound examination to assess the health and well-being of a fetus during pregnancy. The biophysical profile typically evaluates several factors, including fetal movement, fetal tone, fetal breathing movements, and the amount of amniotic fluid surrounding the fetus. This code is specifically used when the assessment is done without including a non-stress test, which is a separate procedure that monitors the fetal heart rate in response to its movements.
When considering the use of modifiers for CPT codes 76818 and 76819, it's important to understand the context in which these codes are used and the specific circumstances of the service provided. 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. If the healthcare provider is only interpreting the results of the fetal biophysical profile and not providing the technical component, this modifier would be appropriate.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. If the facility is providing the equipment and technical staff for the fetal biophysical profile but not the interpretation, this modifier would be applicable.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the fetal biophysical profile is performed in conjunction with another procedure that is not typically reported together. It indicates that the procedures are distinct and separate.
4. Modifier 76 - Repeat Procedure by Same Physician: If the fetal biophysical profile needs to be repeated on the same day by the same physician, this modifier would be used to indicate that the repeat procedure was necessary.
5. Modifier 77 - Repeat Procedure by Another Physician: If the fetal biophysical profile is repeated on the same day by a different physician, this modifier would be used to indicate the repeat service.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although typically used for laboratory tests, if the fetal biophysical profile is repeated for clinical reasons, this modifier might be considered to indicate the necessity of the repeat test.
7. Modifier 52 - Reduced Services: If the fetal biophysical profile is partially completed due to patient circumstances or other factors, this modifier can be used to indicate that the service was reduced.
8. Modifier 53 - Discontinued Procedure: If the procedure is started but discontinued due to patient safety or other reasons, this modifier would be appropriate to indicate that the procedure was not completed.
Each modifier should be used based on the specific circumstances of the service provided and in accordance with payer guidelines and policies. Proper documentation is essential to support the use of any modifier.
The CPT code 76819 is subject to reimbursement by Medicare, but it is essential to verify its status through the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. However, coverage and reimbursement can vary based on local policies established by the MACs, which are responsible for processing Medicare claims and ensuring compliance with Medicare regulations.
Therefore, healthcare providers should consult the MPFS and their respective MAC to confirm the reimbursement status and any specific billing requirements for CPT code 76819.
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