CPT code 91055 is a medical billing code for gastric intubation used to collect a smear for diagnostic testing.
CPT code 91055 is used to describe the procedure of gastric intubation specifically for the purpose of obtaining a smear. This involves inserting a tube into the stomach to collect a sample, which can then be analyzed for various medical conditions. This code is relevant for healthcare providers performing this diagnostic procedure to ensure proper billing and documentation.
For CPT code 91055, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed. This is applicable if the physician is only interpreting the results and not performing the technical aspect of the procedure.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This might apply if the full gastric intubation procedure was not completed.
4. 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. This could be relevant if multiple procedures are performed and need to be billed separately.
5. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician. This might be necessary if the initial procedure did not yield conclusive results.
6. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician. This could occur if a second opinion or additional expertise is required.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same laboratory test is performed multiple times on the same day for the same patient. This could be relevant if multiple smears are required for accurate diagnosis.
10. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided. This ensures that all relevant modifiers are considered in the billing process.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
Determining whether CPT code 91055 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and their corresponding reimbursement rates under Medicare Part B.
To ascertain if CPT code 91055 is reimbursed, you would need to check the MPFS for the current year. If the code is listed with an assigned reimbursement rate, it indicates that Medicare does reimburse for this service. Additionally, MACs, which are private health care insurers that process Medicare claims, may have specific local coverage determinations (LCDs) that could affect reimbursement. These LCDs can provide further clarification on whether CPT code 91055 is covered and under what circumstances.
Therefore, to confirm if CPT code 91055 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC's guidelines.
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