CPT CODES

CPT Code 92987

CPT code 92987 is for the revision of the mitral valve, a procedure to correct or improve the function of this heart valve.

Table of Contents
What is CPT Code 92987
Does CPT 92987 Need a Modifier?
CPT Code 92987 Medicare Reimbursement
Are You Being Underpaid for 92987 CPT Code?
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What is CPT Code 92987

CPT code 92987 is used to describe the procedure of revising a mitral valve. This code is specifically assigned to the surgical intervention where the mitral valve, which is one of the four valves in the heart, is repaired or modified to improve its function. This procedure is typically performed to address issues such as mitral valve stenosis or regurgitation, where the valve does not open or close properly, leading to impaired blood flow. The revision may involve techniques such as reshaping the valve, repairing tears, or adjusting the valve's supporting structures to ensure optimal performance and improve the patient's cardiac health.

Does CPT 92987 Need a Modifier?

For CPT code 92987, which pertains to the revision of the mitral valve, the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty of the procedure.

2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several performed.

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 to identify procedures that are not normally reported together but are appropriate under the circumstances.

4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the collaborative effort.

5. Modifier 66 - Surgical Team: This modifier is applicable when a complex procedure requires the services of a surgical team.

6. 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.

7. 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.

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 patient requires a return to the operating room for a related procedure during the postoperative period.

9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.

These modifiers help provide additional context and detail about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.

CPT Code 92987 Medicare Reimbursement

CPT code 92987 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.

The MPFS outlines the payment rates for services covered by Medicare, and each MAC may have additional local coverage determinations that influence reimbursement.

Therefore, to determine if CPT code 92987 is reimbursed by Medicare, healthcare providers should consult the latest MPFS and contact their regional MAC for any specific coverage policies or requirements.

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