CPT code 91111 is a medical code used to describe gastrointestinal tract imaging within the esophagus for diagnostic purposes.
CPT code 91111 is used to describe a gastrointestinal tract imaging procedure that involves the intraluminal examination of the esophagus. This code specifically refers to the use of imaging techniques to visualize the esophagus from within, allowing healthcare providers to assess conditions affecting this part of the digestive system.
For CPT code 91111, which pertains to gastrointestinal tract imaging within the esophagus, 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 imaging 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 use of the equipment and the performance of the imaging study, not the interpretation.
3. Modifier 52 - Reduced Services: This modifier is used when the service provided is less than what is usually required. It indicates that the procedure was partially reduced or eliminated at the discretion of the provider.
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 procedure 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 is used to identify procedures that are not normally reported together but are appropriate under the circumstances.
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 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
10. 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When determining if a specific CPT code, such as 91111, is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and procedures covered by Medicare, along with their respective reimbursement rates.
For CPT code 91111, you would need to verify its inclusion in the MPFS. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing Medicare policies at the regional level. They can provide further guidance on whether CPT code 91111 is reimbursed and under what specific conditions or limitations.
To summarize, the reimbursement status of CPT code 91111 by Medicare can be confirmed by checking the MPFS and consulting with the relevant MAC for your region.
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