CPT code 77047 is for a bilateral breast MRI with contrast, used to capture detailed images of both breasts for diagnostic purposes.
CPT code 77047 is used to describe a bilateral breast MRI with contrast. This means that the procedure involves using magnetic resonance imaging (MRI) to capture detailed images of both breasts. The use of contrast material helps to enhance the visibility of tissues, making it easier to identify any abnormalities or changes in the breast tissue. This type of imaging is often used for more comprehensive breast examinations, especially in cases where there is a need for a more detailed evaluation beyond what a standard mammogram can provide.
When considering the use of CPT codes for MRI breast procedures, it is 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 the professional component of the service is being billed separately from the technical component. It is applicable if the radiologist is providing only the interpretation of the MRI images.
2. Modifier TC (Technical Component): This modifier is used when the technical component of the service is being billed separately from the professional component. It applies if the facility is billing for the use of the MRI equipment and the performance of the scan.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the MRI procedure is distinct or independent from other services performed on the same day. It helps to indicate that the procedures are not bundled and should be reimbursed separately.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if 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 if the same procedure is repeated by a different physician on the same day. It helps to clarify that the repeat procedure was necessary and not a duplicate billing error.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can sometimes be applicable if the MRI is repeated for clinical reasons, such as verifying results or monitoring treatment progress.
7. Modifier 99 (Multiple Modifiers): This modifier is used when two or more modifiers are necessary to describe the service provided. It indicates that multiple circumstances apply to the procedure.
These modifiers help to provide additional information about the service performed, ensuring that the billing accurately reflects the circumstances of the procedure. Proper use of modifiers can prevent claim denials and ensure appropriate reimbursement.
The CPT code 77047 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors.
The Medicare Physician Fee Schedule (MPFS) provides a standardized payment structure for services covered under Medicare Part B, including those associated with CPT code 77047.
However, the actual reimbursement rate can differ depending on geographic location and other considerations managed by the Medicare Administrative Contractor (MAC) for your region.
Each MAC has the authority to interpret national Medicare policies and establish local coverage determinations, which can influence whether and how much Medicare reimburses for CPT code 77047.
Therefore, it's crucial for healthcare providers to consult their specific MAC for detailed reimbursement information and any additional requirements that may apply.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including 77047, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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