CPT code 91020 is used for gastric motility studies, which assess how well food moves through the stomach and digestive system.
CPT code 91020 is used to describe gastric motility studies, which are diagnostic tests that evaluate the movement and function of the stomach. This procedure typically involves the use of specialized equipment to measure how well the stomach is able to contract and empty its contents. It helps healthcare providers assess conditions related to gastric motility disorders, such as gastroparesis or other gastrointestinal issues.
For CPT code 91020 (Gastric motility studies), the following modifiers may 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 study, not 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 equipment, supplies, and technical staff involved in the study, not the interpretation.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the gastric motility study was not performed in its entirety.
4. 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. It indicates that the gastric motility study was started but not completed.
5. 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 may be used if the gastric motility study is performed in conjunction with other procedures that are not typically reported together.
6. 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. It indicates that the gastric motility study was repeated on the same day.
7. 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. It indicates that the gastric motility study was repeated on the same day by a different provider.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent (multiple) test results. It indicates that the gastric motility study was repeated for diagnostic purposes.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
The CPT code 91020 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may apply to CPT code 91020. This ensures compliance with Medicare guidelines and helps avoid potential claim denials.
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