CPT code 77058 is used for an MRI of one breast, providing detailed imaging to help diagnose conditions or monitor treatment effectiveness.
CPT code 77058 is used to describe a magnetic resonance imaging (MRI) procedure of one breast. This code is specifically for a diagnostic MRI, which is a non-invasive imaging technique that uses magnetic fields and radio waves to create detailed images of the breast tissue. It is typically used to evaluate abnormalities detected in a mammogram or ultrasound, assess the extent of breast cancer, or monitor the response to treatment. This code is applicable when the MRI is performed on only one breast, as opposed to both.
1. -26 (Professional Component): Similar to 77057, this modifier is used when billing only for the professional component, such as the radiologist's interpretation of the MRI.
2. -TC (Technical Component): This modifier is used when billing only for the technical component, which includes the MRI equipment and technician's services.
3. -52 (Reduced Services): This modifier can be applied if the MRI of one breast was not fully completed or if the service was intentionally reduced.
4. -76 (Repeat Procedure by Same Physician): This modifier is used if the MRI needs to be repeated on the same day by the same physician due to technical issues or other valid reasons.
5. -77 (Repeat Procedure by Another Physician): This modifier is applicable if the MRI is repeated on the same day by a different physician.
6. -59 (Distinct Procedural Service): This modifier may be used to indicate that the MRI of one breast is distinct or independent from other services performed on the same day.
These modifiers help ensure accurate billing and reimbursement by providing additional information about the services rendered. Proper use of modifiers is crucial for compliance and optimizing revenue cycle management.
CPT code 77058 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors.
The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including those associated with CPT code 77058.
However, the actual reimbursement amount can differ depending on the geographic location and the specific Medicare Administrative Contractor (MAC) responsible for processing claims in that area.
Each MAC may have slightly different policies or interpretations that can affect reimbursement.
Therefore, healthcare providers should consult the MPFS and their local MAC guidelines to determine the exact reimbursement details for CPT code 77058.
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