CPT code 96912 is for photochemotherapy with UV-A, a treatment combining light therapy and medication to treat skin conditions.
CPT code 96912 is used to describe the procedure of photochemotherapy with UV-A. This treatment involves using ultraviolet A (UV-A) light in combination with a photosensitizing drug to treat various skin conditions, such as psoriasis or vitiligo. The photosensitizing drug makes the skin more responsive to the UV-A light, enhancing the therapeutic effects. This code is essential for accurately documenting and billing this specific type of phototherapy in a patient's medical records.
When billing for CPT code 96912 (Photochemotherapy with UV-A), the following modifiers may be applicable depending on the specific circumstances of the treatment and the patient's condition:
1. Modifier 25: Significant, separately identifiable evaluation and management 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 on the same day as the photochemotherapy.
2. Modifier 26: Professional component. Use this modifier if only the professional component of the service is being billed.
3. Modifier 50: Bilateral procedure. Use this modifier if the photochemotherapy was performed on both sides of the body.
4. Modifier 52: Reduced services. Use this modifier if the service provided was less than usually required.
5. 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.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. Use this modifier if the photochemotherapy was repeated on the same day by a different provider.
7. Modifier 78: Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient had to return for additional photochemotherapy related to the initial treatment.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the photochemotherapy is unrelated to the initial procedure performed during the postoperative period.
9. Modifier 91: Repeat clinical diagnostic laboratory test. Use this modifier if the photochemotherapy involves repeated diagnostic tests.
10. Modifier 99: Multiple modifiers. Use this modifier if more than four modifiers are necessary to describe the service.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements or restrictions regarding the use of these modifiers.
The CPT code 96912, which pertains to photochemotherapy with UV-A, is reimbursed by Medicare. Reimbursement for this code is determined based on the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. Additionally, the specific reimbursement details and any potential coverage limitations may vary depending on the region and the Medicare Administrative Contractor (MAC) responsible for processing claims in that area. It is advisable for healthcare providers to consult the MPFS and their respective MAC for the most accurate and up-to-date information regarding reimbursement for CPT code 96912.
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