CPT code 76830 is for a transvaginal ultrasound procedure used to examine female pelvic organs, excluding obstetric evaluations.
CPT code 76830 is used to describe a transvaginal ultrasound procedure that is performed for non-obstetric purposes. This means the ultrasound is conducted via the vagina to examine the pelvic organs, such as the uterus, ovaries, and other structures, but it is not related to pregnancy. This diagnostic imaging technique is often used to investigate symptoms like pelvic pain, abnormal bleeding, or to evaluate conditions such as ovarian cysts or fibroids.
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 exam, 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 the technician's time, excluding the interpretation.
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. It may be necessary if the ultrasound is performed in conjunction with other procedures that are typically bundled.
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. It indicates that the repeat procedure was necessary and not a duplicate billing error.
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 indicates that the repeat procedure was necessary and not a duplicate billing error.
6. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier is used if the procedure required an unplanned return to the procedure room on the same day. It indicates that the return was necessary due to complications or other unforeseen circumstances.
7. Modifier 79 (Unrelated Procedure or Service by the Same Physician): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period of another procedure. It indicates that the procedure is not related to the original surgery.
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 results. It indicates that the repeat test was necessary for clinical reasons.
9. Modifier XE (Separate Encounter): This modifier is used to indicate that a service was performed during a separate encounter on the same day as another service. It helps clarify that the services were distinct and not part of the same session.
10. Modifier XS (Separate Structure): This modifier is used to indicate that a service was performed on a separate organ or structure. It helps clarify that the services were distinct and not part of the same anatomical site.
11. Modifier XP (Separate Practitioner): This modifier is used to indicate that a service was performed by a different practitioner. It helps clarify that the services were distinct and not performed by the same provider.
12. Modifier XU (Unusual Non-Overlapping Service): This modifier is used to indicate that a service does not overlap with another service performed on the same day. It helps clarify that the services were distinct and not part of the same procedure.
CPT code 76830 is subject to reimbursement by Medicare, but whether it is reimbursed can depend on several factors, including the specifics of the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the local Medicare Administrative Contractor (MAC).
The MPFS provides a list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered, and it includes information on whether a particular CPT code, such as 76830, is covered and at what rate.
Additionally, MACs, which are private health insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims, may have specific local coverage determinations (LCDs) that affect the reimbursement of CPT code 76830.
Therefore, it is crucial for healthcare providers to verify the coverage and reimbursement specifics with their local MAC to ensure compliance and proper billing practices.
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