CPT code 93287 is used for evaluating and programming a peri-procedural device, essential for accurate healthcare service documentation.
CPT code 93287 is used to describe the evaluation and programming of a peri-procedural device. This code is typically applied when a healthcare provider assesses and adjusts a cardiac device, such as a pacemaker or defibrillator, around the time of a surgical or interventional procedure. The evaluation ensures that the device is functioning correctly and is appropriately programmed to meet the patient's needs during and after the procedure. This code is crucial for billing purposes, as it helps healthcare providers receive reimbursement for the specialized services they provide in managing and optimizing cardiac devices.
For CPT code 93287, which involves the evaluation and programming of a peri-procedural device, several modifiers may be applicable depending on the specific circumstances of the service provided. Here is a list of potential modifiers that could be used:
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 or evaluation aspect of the service, 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 equipment, supplies, and technical staff, excluding the professional interpretation.
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 prevent bundling of services that are typically considered part of a larger procedure.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by the same provider on the same day. It indicates that the repeat service was necessary and not a duplicate billing error.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by a different provider on the same day. It signifies that the repeat service was necessary and not a duplicate billing error.
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 patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure or service is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although not typically associated with device evaluations, this modifier is used when a laboratory test is repeated on the same day to obtain subsequent results.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 93287 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually. To determine the exact reimbursement rate for CPT code 93287, healthcare providers should refer to the MPFS for the current year.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and may have specific local coverage determinations (LCDs) that affect the reimbursement of CPT code 93287. These LCDs can vary by region, so it is essential for healthcare providers to consult their respective MAC for any additional guidelines or requirements that may impact reimbursement for this code.
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