CPT code 95012 is a medical code used to identify the test for measuring exhaled nitric oxide levels in patients, often for asthma assessment.
CPT code 95012 is used for the measurement of exhaled nitric oxide. This procedure involves assessing the concentration of nitric oxide in a patient's exhaled breath, which can be an important indicator of airway inflammation. It is commonly used in the management and diagnosis of asthma and other respiratory conditions. By measuring the levels of nitric oxide, healthcare providers can gain insights into the effectiveness of treatment plans and make necessary adjustments to better manage the patient's respiratory health.
For CPT code 95012, which pertains to the measurement of exhaled nitric oxide, the following modifiers may be applicable:
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 of the test results, 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 and supplies necessary to perform the test, excluding the 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 respiratory tests are performed and need to be billed 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 test was necessary to be performed more than once.
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 indicates that the test was necessary to be performed more than once by a different provider.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a laboratory test is repeated on the same day to obtain subsequent test results. It is applicable if the test needs to be repeated for clinical reasons.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It is important to use them appropriately to avoid claim denials or delays.
CPT code 95012, which involves a specific medical procedure, is reimbursed by Medicare under certain 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, it's important to note that coverage and reimbursement can vary based on the local policies set by the Medicare Administrative Contractor (MAC) in your region. Each MAC has the authority to establish specific guidelines and requirements for coverage, which can influence whether CPT code 95012 is reimbursed in a particular area.
Therefore, healthcare providers should consult their local MAC for detailed information on the reimbursement criteria for this code.
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