CPT code 96910 is for photochemotherapy with UV-B, a treatment combining light therapy and medication to treat skin conditions.
CPT code 96910 is used to describe the procedure of photochemotherapy with UV-B. This involves treating a patient with ultraviolet B (UV-B) light in combination with a photosensitizing agent to manage various skin conditions, such as psoriasis or eczema. The treatment aims to reduce symptoms by slowing down the growth of affected skin cells.
When billing for CPT code 96910 (Photochemotherapy with UV-B), several modifiers may be applicable depending on the specific circumstances of the treatment. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the photochemotherapy.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the photochemotherapy was distinct or independent from other services performed on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the photochemotherapy was repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used if the photochemotherapy was repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although less common, this modifier may be used if the photochemotherapy involves repeated diagnostic tests on the same day.
6. Modifier 52: Reduced services. Use this modifier if the photochemotherapy service was partially reduced or eliminated at the physician's discretion.
7. Modifier 53: Discontinued procedure. This modifier is used if the photochemotherapy was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 22: Increased procedural services. Use this modifier if the photochemotherapy required significantly more work than typically required.
9. Modifier 63: Procedure performed on infants less than 4 kg. This modifier is used if the photochemotherapy was performed on an infant weighing less than 4 kilograms.
10. Modifier 24: Unrelated evaluation and management service by the same physician during a postoperative period. Use this modifier if an unrelated E/M service was provided during the postoperative period of another procedure.
11. 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 if the patient had to return for additional photochemotherapy related to the initial procedure.
12. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the photochemotherapy was unrelated to a procedure performed during the postoperative period.
These modifiers help provide additional information about the circumstances under which the photochemotherapy was performed, ensuring accurate billing and reimbursement.
The CPT code 96910, which is for photochemotherapy with UV-B, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. Additionally, it is important to consult with the specific Medicare Administrative Contractor (MAC) for your region, as they are responsible for processing Medicare claims and can provide detailed information on coverage policies and any potential local variations in reimbursement.
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