CPT code 77052 is for an additional screening mammogram, used to enhance the evaluation of breast tissue during routine breast cancer screenings.
CPT code 77052 is an add-on code used to describe a computer-aided detection (CAD) procedure that is performed in conjunction with a screening mammogram. This code is used when a radiologist utilizes specialized computer software to assist in the interpretation of mammographic images, enhancing the detection of breast cancer. It is important to note that this code is used in addition to the primary screening mammogram code, as it represents an additional service provided during the mammography process.
When dealing with CPT codes 77051 and 77052, it's 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 service provided is the professional component of a procedure, such as the interpretation of the mammogram by a radiologist. It is applicable if the technical component (equipment, supplies, and technical staff) is billed separately.
2. Modifier TC (Technical Component): This modifier is used when billing for the technical component of the service, which includes the use of equipment and technical staff. It is applicable if the professional component is billed separately.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the mammogram is performed in conjunction with other procedures that are not typically reported together, to indicate that the services are distinct and separate.
4. Modifier 76 (Repeat Procedure by Same Physician): If the mammogram needs to be repeated on the same day by the same physician, this modifier can be used to indicate that the procedure was repeated.
5. Modifier 77 (Repeat Procedure by Another Physician): If the mammogram is repeated on the same day by a different physician, this modifier is used to indicate the repeat service.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although less common for imaging, this modifier can be used if the mammogram is repeated for clinical reasons, such as verifying results or due to technical issues with the initial test.
These modifiers help clarify the nature of the service provided and ensure that the billing accurately reflects the work performed, facilitating proper reimbursement from payers. Always verify payer-specific guidelines, as requirements for modifiers can vary.
CPT code 77052 is associated with an add-on procedure. When it comes to reimbursement by Medicare, it's important to note that add-on codes are typically reimbursed only when they are billed in conjunction with a primary procedure.
The Medicare Physician Fee Schedule (MPFS) provides guidance on the reimbursement rates for various CPT codes, including add-ons like 77052. However, the reimbursement for this specific code can vary based on the policies of the Medicare Administrative Contractor (MAC) in your region, as they have the authority to determine coverage and payment specifics.
Therefore, it's crucial for healthcare providers to verify with their local MAC to ensure that CPT code 77052 is reimbursed under the specific circumstances of its use.
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