CPT code 96904 is a medical billing code used for whole body photography, a procedure to document skin conditions for diagnosis and treatment.
CPT code 96904 is used for whole body photography. This code is specifically designated for capturing comprehensive photographic images of the entire body, which can be essential for monitoring skin conditions, documenting dermatological changes, or tracking the progression of diseases such as melanoma. This procedure helps healthcare providers maintain a visual record that can be compared over time to detect any new or evolving skin abnormalities.
When billing for CPT code 96904 (Whole body photography), the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the images.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, such as the actual photography.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Used when a related procedure is performed during the postoperative period of the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements or restrictions regarding the use of these modifiers.
CPT code 96904, which pertains to whole body photography, is not reimbursed by Medicare. According to the Medicare Physician Fee Schedule (MPFS), this particular service is not covered. Additionally, Medicare Administrative Contractors (MACs) do not provide reimbursement for this code, as it is considered a non-covered service under Medicare guidelines. Healthcare providers should be aware of this when billing for services and consider alternative coding or payment options for patients requiring this service.
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