CPT code 77046 is for a unilateral breast MRI with contrast, used to capture detailed images of one breast for diagnostic purposes.
CPT code 77046 is used to describe a magnetic resonance imaging (MRI) procedure of one breast, performed with the use of contrast material. This imaging technique is typically employed to provide detailed images of breast tissue, which can help in the diagnosis and evaluation of breast abnormalities, such as tumors or lesions. The use of contrast material enhances the visibility of certain structures within the breast, allowing for a more precise assessment. This code specifically applies when the MRI is conducted on only one breast.
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 imaging study, not the technical component.
2. Modifier TC - Technical Component
- This modifier is applied 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 professional 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 multiple imaging services are performed and need to be billed separately.
4. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure or service is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 52 - Reduced Services
- This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.
7. Modifier 53 - Discontinued Procedure
- This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 22 - Increased Procedural Services
- This modifier is used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 77046 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors.
The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of fees that Medicare will pay for each service, including CPT code 77046. However, the actual reimbursement rate may differ depending on the geographical location and the specific policies of the Medicare Administrative Contractor (MAC) that oversees claims in that region.
Each MAC has the authority to interpret Medicare policies and set reimbursement rates within the guidelines provided by the Centers for Medicare & Medicaid Services (CMS). Therefore, healthcare providers should consult their local MAC and the MPFS to determine the exact reimbursement details for CPT code 77046.
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