CPT CODES

CPT Code 93325

CPT code 93325 is used for Doppler color flow imaging, an add-on procedure that provides detailed visuals of blood flow within the heart.

Table of Contents
What is CPT Code 93325
Does CPT 93325 Need a Modifier?
CPT Code 93325 Medicare Reimbursement
Are You Being Underpaid for 93325 CPT Code?
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What is CPT Code 93325

CPT code 93325 is an add-on code used to describe the Doppler color flow imaging technique, which is an enhancement to echocardiography procedures. This code is specifically utilized when a color Doppler study is performed in conjunction with a primary echocardiographic examination. The Doppler color flow imaging provides a visual representation of blood flow through the heart and its valves, allowing healthcare providers to assess the direction and velocity of blood flow, identify any abnormalities, and evaluate the function of the heart's chambers and valves. As an add-on code, 93325 is not billed independently but is used in addition to the primary echocardiography procedure code to reflect the additional work and resources involved in performing the color flow study.

Does CPT 93325 Need a Modifier?

For CPT code 93325, which is an add-on code for Doppler color flow imaging, the following modifiers may be applicable:

1. Modifier 26 - Professional Component: This modifier is used when the professional component of the service is being billed separately from the technical component. It indicates that the provider is billing only for the interpretation of the Doppler color flow study.

2. Modifier TC - Technical Component: This modifier is used when the technical component of the service is being billed separately from the professional component. It indicates that the provider is billing only for the use of equipment and technician services.

3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the Doppler color flow study is performed as a distinct service from other procedures performed on the same day. It is used to indicate that the service is not bundled with other procedures.

4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the Doppler color flow study needs to be repeated by the same physician on the same day for the same patient.

5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the Doppler color flow study is repeated by a different physician on the same day for the same patient.

6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can be applicable if the Doppler color flow study is repeated for clinical reasons on the same day.

These modifiers help ensure accurate billing and reimbursement by providing additional information about the circumstances under which the Doppler color flow study was performed. It is important to use them appropriately to avoid claim denials or delays.

CPT Code 93325 Medicare Reimbursement

CPT code 93325, which is an add-on code, is reimbursed by Medicare under specific conditions. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. However, as an add-on code, 93325 must be billed in conjunction with a primary procedure code that is also covered by Medicare.

The reimbursement specifics, including whether the code is covered in a particular region, can vary based on the guidelines set by the Medicare Administrative Contractor (MAC) responsible for the geographic area where the service is provided. Each MAC has the authority to interpret national Medicare policies and may have local coverage determinations (LCDs) that affect the reimbursement of certain codes, including add-on codes like 93325. Therefore, healthcare providers should verify with their respective MAC to ensure compliance with local policies and confirm the reimbursement status of CPT code 93325.

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