CPT code 91010 is a medical billing code used for an esophagus motility study, which assesses how well the esophagus functions.
CPT code 91010 is a procedure that involves an esophagus motility study, which is used to evaluate the function of the esophagus. This test measures the muscle contractions and coordination of the esophagus as it moves food from the throat to the stomach. It helps healthcare providers diagnose conditions such as gastroesophageal reflux disease (GERD), achalasia, and other motility disorders.
For CPT code 91010 (Esophagus motility study), the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, typically by the physician who interprets the results.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, typically by the facility that provides the equipment and technician.
3. Modifier 52 - Reduced Services: Used when the service provided is less extensive than described in the CPT code.
4. Modifier 53 - Discontinued Procedure: Used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician repeats the procedure on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Used when a different physician repeats the procedure on the same day.
7. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help in providing additional information about the performed procedure, ensuring accurate billing and reimbursement.
Determining if the CPT code 91010 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including their reimbursement rates. To verify if CPT code 91010 is reimbursed, you would need to check the MPFS for the specific year in question.
Additionally, MACs may have specific local coverage determinations (LCDs) that can affect reimbursement. Therefore, it is crucial to review both the MPFS and any relevant LCDs issued by your MAC to confirm if CPT code 91010 is reimbursed by Medicare.
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