CPT code 96913 is for photochemotherapy using UV-A or UV-B light, a treatment for skin conditions like psoriasis and eczema.
CPT code 96913 is used to describe the procedure of photochemotherapy involving ultraviolet A (UVA) or ultraviolet B (UVB) light. This treatment is commonly used for various skin conditions, such as psoriasis, eczema, and vitiligo. During the procedure, the patient's skin is exposed to UVA or UVB light, often in combination with a photosensitizing agent, to help reduce symptoms and improve skin appearance. This code is essential for accurately documenting and billing for this specific type of phototherapy treatment in a healthcare setting.
For CPT code 96913, "Photochemotherapy (PUVA) or UV-B," the following modifiers may be applicable:
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 is provided on the same day as the photochemotherapy.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the photochemotherapy service is 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 is 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 is 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. This modifier is used if the photochemotherapy service provided is less than the usual service described by the CPT code.
7. Modifier 53: Discontinued procedure. Use this modifier if the photochemotherapy is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 22: Increased procedural services. This modifier is used if the photochemotherapy service provided is significantly greater than typically required.
9. Modifier 63: Procedure performed on infants less than 4 kg. This modifier is used if the photochemotherapy is performed on an infant weighing less than 4 kilograms.
10. 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 needs to return for additional photochemotherapy within the postoperative period.
These modifiers help provide additional information about the circumstances under which the photochemotherapy service was provided, ensuring accurate billing and reimbursement.
When determining if CPT code 96913 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various healthcare services, including those identified by CPT codes.
For CPT code 96913, you would need to verify its inclusion and the associated reimbursement rate in the MPFS. Additionally, since MACs have the authority to interpret national policies and make local coverage determinations, it is crucial to check with your specific MAC to confirm if CPT code 96913 is covered and under what conditions. This dual verification process ensures that you have the most accurate and region-specific information regarding Medicare reimbursement for CPT code 96913.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 96913. Don't let underpayments slip through the cracks—schedule a demo today and see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
