CPT code 76880 is for an ultrasound exam of an extremity, used to assess soft tissues, joints, or other structures in arms or legs.
CPT code 76880 is used for an ultrasound examination of an extremity. This code specifically refers to a non-invasive imaging procedure that uses sound waves to create images of the soft tissues, muscles, tendons, and other structures in an arm or leg. The ultrasound helps healthcare providers diagnose conditions such as tears, inflammation, or other abnormalities in the extremities. This procedure is typically performed when there is a need to assess injuries or monitor ongoing conditions affecting the limbs.
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 study, 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 study, excluding the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the ultrasound study is performed in conjunction with another procedure, and it is necessary to indicate that the ultrasound is a distinct and separate service.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the ultrasound study needs to be repeated on the same day by the same physician due to medical necessity.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the ultrasound study is repeated on the same day by a different physician.
6. Modifier 52 (Reduced Services): This modifier can be used if the ultrasound study is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 (Discontinued Procedure): This modifier is applicable if the ultrasound study is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 22 (Increased Procedural Services): This modifier may be used if the ultrasound study required significantly more effort or time than typically required.
9. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service): This modifier is used when an evaluation and management service is performed on the same day as the ultrasound study and is distinct and separately identifiable from the ultrasound service.
10. Modifier 50 (Bilateral Procedure): This modifier is applicable if the ultrasound study is performed bilaterally during the same session.
CPT code 76880 is included in the Medicare Physician Fee Schedule (MPFS), which means it is generally eligible for reimbursement by Medicare. However, the reimbursement for this code can vary based on several factors, including geographic location and specific coverage policies.
Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement rates and coverage specifics for CPT code 76880 in different regions. It is essential for healthcare providers to verify with their local MAC to understand the exact reimbursement details and any potential coverage limitations for this particular CPT code.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and pinpointing underpayments down to the CPT code level, including specific codes like 76880. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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