CPT code 96902 is a medical code used to describe the procedure of performing a trichogram, which is a hair analysis test.
CPT code 96902 is used to describe a trichogram, which is a diagnostic test that involves examining hair samples under a microscope. This procedure helps healthcare providers assess hair growth patterns, hair loss, and scalp conditions by analyzing the hair's structure and growth cycle. It is often used in dermatology to diagnose conditions like alopecia and other hair disorders.
For CPT code 96902 (Trichogram), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the service provided required significantly greater effort than typically required.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Apply this modifier when an evaluation and management (E/M) service is performed on the same day as the trichogram and is distinct from the procedure.
3. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed, typically when the interpretation of the test is performed separately from the technical component.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the trichogram was a distinct procedural service from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the trichogram was repeated by the same provider on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the trichogram was repeated by a different provider on the same day.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- This modifier is used when the trichogram is repeated for clinical reasons 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 to ensure accurate billing and reimbursement.
The CPT code 96902 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect the reimbursement of CPT code 96902. Each MAC may have unique policies or requirements that could influence the reimbursement process.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 96902. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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