CPT code 91200 is a medical billing code used to describe liver elastography, a test that measures liver stiffness for assessing liver health.
CPT code 91200 is used to describe a non-invasive procedure known as liver elastography. This procedure assesses the stiffness of the liver, which can help in diagnosing and monitoring liver diseases, such as fibrosis or cirrhosis. By measuring the elasticity of liver tissue, healthcare providers can gain valuable insights into the liver's health without the need for more invasive methods like a biopsy.
For CPT code 91200 (Liver elastography), 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 liver elastography 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 the equipment and the performance of the liver elastography, not the interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the liver elastography was a distinct service performed separately from other procedures on the same day. It helps to avoid bundling issues and ensures proper reimbursement.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the liver elastography is repeated by the same physician on the same day. It indicates that the repeat procedure was necessary and not a duplicate billing.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the liver elastography is repeated by a different physician on the same day. It indicates that the repeat procedure was necessary and performed by another provider.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when the liver elastography is repeated for clinical reasons, such as to confirm initial results. It indicates that the repeat test was medically necessary.
7. Modifier 52 - Reduced Services: This modifier is used when the liver elastography service provided was less than usually required. It indicates that the procedure was partially completed or modified due to specific circumstances.
8. Modifier 53 - Discontinued Procedure: This modifier is used when the liver elastography procedure is started but discontinued due to patient safety or other reasons. It indicates that the procedure was not completed as planned.
9. Modifier 22 - Increased Procedural Services: This modifier is used when the liver elastography procedure requires significantly more effort or time than usual. It indicates that the service was more complex or difficult than typically expected.
10. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: This modifier is used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the liver elastography. It indicates that the E/M service was above and beyond the usual preoperative and postoperative care associated with the procedure.
These modifiers help ensure accurate billing and appropriate reimbursement for liver elastography services.
The CPT code 91200 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including their reimbursement rates. However, coverage and reimbursement can vary based on the MAC's local policies and guidelines.
Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 91200.
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