CPT code 92974 is used for catheter placement in cardiac brachytherapy, a procedure to treat heart conditions by delivering radiation.
CPT code 92974 is used to describe the procedure of catheter placement for cardiac brachytherapy. This involves the insertion of a catheter into the heart or nearby vessels to deliver localized radiation therapy. Cardiac brachytherapy is typically used to treat restenosis, which is the re-narrowing of a blood vessel, often after a procedure like angioplasty. The catheter serves as a conduit to deliver radiation directly to the affected area, helping to prevent further narrowing and improve blood flow. This code is crucial for billing and documentation purposes, ensuring that healthcare providers are accurately reimbursed for the specialized service provided.
For CPT code 92974, which involves catheter placement for cardiac brachytherapy, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component, such as the interpretation of the procedure, rather than the technical component.
2. Modifier TC - Technical Component: This modifier is used when the service provided is the technical component, such as the use of equipment and supplies, rather than the professional component.
3. 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 when no other modifier more appropriately describes the relationship of the procedure to other services.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure 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: This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
These modifiers help clarify the specifics of the service provided and ensure accurate billing and reimbursement. It is important to review the specific circumstances of each case to determine the appropriate use of modifiers.
CPT code 92974 is associated with a specific medical procedure, and whether it is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 92974 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this procedure, subject to any applicable conditions or limitations.
However, the final determination of reimbursement also involves the local MAC, which administers Medicare claims for specific regions. MACs have the authority to interpret national Medicare policies and may have additional guidelines or coverage determinations that affect whether CPT code 92974 is reimbursed in their jurisdiction.
Therefore, to ascertain if CPT code 92974 is reimbursed by Medicare, healthcare providers should consult the MPFS for the national reimbursement rate and check with their local MAC for any specific coverage policies or requirements that may apply.
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