CPT code 91120 is a code used to identify a rectal sensation test, which assesses nerve function in the rectal area for diagnostic purposes.
CPT code 91120 is a procedure used to evaluate rectal sensation. This test assesses the ability of the rectum to detect sensations, which can help diagnose various gastrointestinal conditions. It involves the insertion of a specialized device into the rectum to measure the patient's response to different levels of pressure or sensation, providing valuable information about rectal function and potential abnormalities.
Modifiers for CPT Code 91120 - Rectal Sensation Test:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the rectal sensation test required significantly more work than typically required. This could be due to patient-specific factors or complications.
2. Modifier 26 - Professional Component
- Apply this modifier when only the professional component of the rectal sensation test is being billed. This typically involves the interpretation of the test results by a physician.
3. Modifier 52 - Reduced Services
- Use this modifier if the rectal sensation test was partially reduced or eliminated at the physician's discretion. This could occur if the test was not fully completed due to patient intolerance or other factors.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- This modifier is applicable if the rectal sensation test needs to be repeated by the same provider on the same day due to clinical necessity.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier if the rectal sensation test is repeated by a different provider on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient needs to return for a related rectal sensation test during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the rectal sensation test is performed during the postoperative period of another procedure but is unrelated to the initial surgery.
8. Modifier 99 - Multiple Modifiers
- This modifier is used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used in accordance with the clinical scenario and payer guidelines to ensure accurate billing and reimbursement.
Determining whether the CPT code 91120 (Rectal sensation test) is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually.
To verify if CPT code 91120 is reimbursed, you would first check the MPFS to see if the code is listed and if there is an associated fee. If the code is present with an assigned fee, it indicates that Medicare reimburses for this service under the MPFS.
Additionally, it is crucial to review the Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) provided by your MAC. These documents offer detailed information on coverage criteria, including any specific conditions or limitations that must be met for Medicare to reimburse the service.
In summary, to determine if CPT code 91120 is reimbursed by Medicare, you need to:
1. Check the Medicare Physician Fee Schedule (MPFS) for the code and its associated fee.
2. Review the Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) from your Medicare Administrative Contractor (MAC) for any specific coverage guidelines.
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