CPT code 93571 is used for measuring heart flow reserve, a procedure that assesses blood flow in coronary arteries to evaluate heart function.
CPT code 93571 is used to describe the procedure of measuring the heart's flow reserve, specifically known as Fractional Flow Reserve (FFR). This procedure involves assessing the pressure differences across a coronary artery stenosis to determine the likelihood of the stenosis impeding oxygen delivery to the heart muscle. It is typically performed during a cardiac catheterization and helps cardiologists decide whether a patient might benefit from interventions such as angioplasty or stenting. By providing a more precise evaluation of coronary artery disease, this measurement aids in tailoring treatment plans to improve patient outcomes.
For CPT code 93571, which pertains to the measurement of heart flow reserve, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the physician performs only the professional component of the service, such as the interpretation of the results, without providing the technical component.
2. Modifier TC - Technical Component: This modifier is applied when only the technical component of the service is provided, such as the use of equipment and supplies, without 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 may be necessary if multiple procedures are performed and need to be reported separately.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day. It indicates that the procedure was necessary and not a duplicate billing error.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It helps clarify that the repeat procedure 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 returns to the operating room for a related procedure 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 a procedure or service is performed by the same physician during the postoperative period of another procedure, but it is unrelated to the original procedure.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It's important for healthcare providers to use the appropriate modifiers to avoid claim denials and ensure compliance with payer requirements.
CPT code 93571 is associated with a procedure that may be reimbursed by Medicare, but this is contingent upon several factors, including the specifics of the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates, which are updated annually. However, coverage and reimbursement can vary based on the MAC's local coverage determinations (LCDs) and national coverage determinations (NCDs).
Therefore, it is essential for healthcare providers to verify with their specific MAC to determine if CPT code 93571 is reimbursed in their region and under what conditions. This ensures compliance with Medicare's billing requirements and maximizes the likelihood of successful reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including CPT code 93571. Schedule a demo today to see how RevFind can help you maximize your reimbursements and ensure you're receiving the full payment you deserve from each payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
