CPT code 77079 is for a CT scan that measures bone density in peripheral areas, helping assess bone health and risk of fractures.
CPT code 77079 is used for a CT bone density test that focuses on peripheral areas of the body, such as the arms or legs. This test is designed to measure the density and strength of bones in these specific regions, helping healthcare providers assess the risk of fractures or diagnose conditions like osteoporosis. By using CT technology, this procedure provides detailed images that can aid in the evaluation of bone health in peripheral areas.
For CPT codes 77078 and 77079, the use of modifiers may be necessary depending on the specific circumstances of the procedure and the payer requirements. Here is a list of potential modifiers that could be applicable:
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 test results rather than the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and facilities, excluding the professional interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the 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 when the same procedure is repeated by the same physician on the same day. It indicates that the repeat procedure was necessary and should be considered for separate reimbursement.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It signifies that the repeat procedure was necessary and should be considered for separate reimbursement.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for imaging procedures, this modifier may be applicable if a repeat test is performed to obtain subsequent results for the same patient on the same day.
It is important to verify with specific payer policies and guidelines, as the necessity and applicability of modifiers can vary. Proper documentation should support the use of any modifiers to ensure accurate billing and reimbursement.
When considering the reimbursement of CPT code 77079 by Medicare, it's essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) specific to your region. The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates. However, coverage can vary based on local policies established by MACs, which are responsible for processing Medicare claims and determining coverage specifics in different jurisdictions.
To determine if CPT code 77079 is reimbursed by Medicare, healthcare providers should verify the MPFS for the current year and consult their regional MAC for any local coverage determinations (LCDs) that might affect reimbursement. It's important to note that even if a service is listed on the MPFS, MACs may have additional requirements or documentation needs that must be met for reimbursement. Therefore, staying informed about both national and local Medicare policies is crucial for accurate billing and reimbursement.
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 CPT code 77079, 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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