CPT code 77051 is for a computer-aided diagnostic mammogram used as an add-on to enhance the detection of breast abnormalities.
CPT code 77051 is used to describe a computer-aided detection (CAD) add-on service for mammography. This code is specifically for when CAD is utilized in conjunction with a diagnostic mammogram. The CAD system assists radiologists by highlighting areas of interest on the mammogram images that may require further analysis, thereby enhancing the accuracy of the diagnostic process. This code is an add-on, meaning it is used in addition to the primary diagnostic mammography procedure code.
1. Modifier 26 (Professional Component): This modifier is used when the service provided is the professional component of a procedure that has both a professional and technical component. It is applicable when the interpretation of the imaging is performed separately from the technical execution.
2. Modifier TC (Technical Component): This modifier is used when the service provided is the technical component of a procedure that has both a professional and technical component. It is applicable when the imaging is performed without 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 is applicable when the procedure is not typically reported together but is appropriate under the circumstances.
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 another physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can be applicable if the imaging procedure is repeated for clinical reasons on the same day.
7. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
8. 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.
9. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required.
10. Modifier 63 (Procedure Performed on Infants less than 4 kg): This modifier is used when procedures are performed on neonates and infants up to a present body weight of 4 kg to indicate the increased complexity of the service.
CPT code 77051, which is an add-on code, is subject to specific reimbursement guidelines under Medicare. Whether or not this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies set by the local Medicare Administrative Contractor (MAC).
As an add-on code, 77051 is typically reimbursed only when billed in conjunction with a primary procedure that is covered under the MPFS. The MPFS outlines the payment rates for services and procedures, and add-on codes like 77051 are generally reimbursed when they are deemed medically necessary and are performed as part of a comprehensive service.
Additionally, each MAC has the authority to establish local coverage determinations (LCDs) that can affect reimbursement. These LCDs may specify conditions under which CPT code 77051 is covered, including documentation requirements and medical necessity criteria.
Healthcare providers should verify the specific reimbursement policies for CPT code 77051 with their local MAC and ensure compliance with any applicable LCDs to determine if Medicare will reimburse this code in their particular circumstances.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments, even down to the specific CPT code level, such as 77051, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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