CPT code 91065 is a code used to bill for a breath hydrogen/methane test, which helps diagnose digestive issues.
CPT code 91065 is used to describe a breath hydrogen/methane test, which is a diagnostic procedure that measures the levels of hydrogen and methane in a patient's breath. This test is typically performed to evaluate conditions related to carbohydrate malabsorption, such as lactose intolerance or small intestinal bacterial overgrowth (SIBO). During the test, the patient ingests a specific carbohydrate solution, and breath samples are collected at regular intervals to analyze the gases produced by the gut microbiota. The results help healthcare providers determine the presence of digestive disorders and guide appropriate treatment options.
For CPT code 91065 (Breath hydrogen/methane test), the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the test results by a physician.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, such as the use of equipment and supplies for the test.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day. This can be necessary if multiple tests or procedures are performed that are not typically reported together.
4. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician repeats the procedure on the same day. This might be necessary if the initial test results were inconclusive and a repeat test is required.
5. Modifier 77 - Repeat Procedure by Another Physician: Used when a different physician repeats the procedure on the same day. This could occur in a multi-specialty practice where another specialist needs to confirm the results.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same test is performed more than once on the same day for the same patient to obtain subsequent test results. This is particularly relevant if the test needs to be repeated to monitor changes in the patient's condition.
These modifiers help provide additional information about the circumstances under which the breath hydrogen/methane test was performed, ensuring accurate billing and reimbursement.
The CPT code 91065, which is used for a breath hydrogen/methane test, is reimbursed by Medicare under specific conditions. 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 and coverage criteria for various CPT codes.
Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for specific guidelines and policies. MACs are responsible for processing Medicare claims and can provide region-specific information regarding the reimbursement of CPT code 91065. Coverage may vary based on the MAC's local coverage determinations (LCDs) and other relevant policies. Therefore, verifying with the MAC ensures compliance with Medicare's reimbursement criteria for this test.
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