CPT code 91035 is a test for gastroesophageal reflux using electrodes to measure acid levels in the esophagus.
CPT code 91035 is for a gastroesophageal reflux test that is performed with the use of electrodes. This procedure is designed to evaluate the presence and severity of gastroesophageal reflux disease (GERD) by measuring the pH levels in the esophagus over a specified period. The test helps healthcare providers assess how often and for how long stomach acid enters the esophagus, aiding in the diagnosis and management of reflux-related conditions.
Modifiers for CPT Code 91035 (G-esoph reflx tst w/electrod):
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, 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 use of equipment and supplies, but not the interpretation of the results.
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 full service was not provided.
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.
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 is used to avoid bundling issues.
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 or service.
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 or service.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when the same laboratory test is performed on the same patient on the same day to obtain subsequent (multiple) test results.
These modifiers help in accurately reporting and billing for the services provided, ensuring proper reimbursement and compliance with payer requirements.
The CPT code 91035, which is for a specific medical procedure, is reimbursed by Medicare. To determine if this particular CPT code is covered, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 91035. Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC) as they are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 91035.
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