CPT code 96920 is for laser treatment of skin areas less than 250 square centimeters.
CPT code 96920 is used to describe a laser treatment procedure for the skin that covers an area of less than 250 square centimeters. This code is typically utilized by healthcare providers to document and bill for laser therapies aimed at treating various skin conditions within the specified area size.
When using CPT code 96920 for laser treatment of skin less than 250 square centimeters, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified health care professional on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the laser treatment.
2. Modifier 50: Bilateral procedure. Use this modifier if the laser treatment was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same session.
4. Modifier 52: Reduced services. Use this modifier if the service provided was less extensive than described in the CPT code.
5. Modifier 59: Distinct procedural service. Use this modifier to indicate that the laser treatment was distinct or independent from other services performed on the same day.
6. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the laser treatment was repeated on the same day.
7. Modifier 77: Repeat procedure by another physician or other qualified health care professional. Use this modifier if the laser treatment was repeated on the same day by a different provider.
8. Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient had to return for additional laser treatment related to the initial procedure.
9. Modifier 79: Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period. Use this modifier if the laser treatment was unrelated to the initial procedure performed during the postoperative period.
10. Modifier LT: Left side. Use this modifier if the laser treatment was performed on the left side of the body.
11. Modifier RT: Right side. Use this modifier if the laser treatment was performed on the right side of the body.
12. Modifier XS: Separate structure. Use this modifier to indicate that the laser treatment was performed on a separate anatomical structure from other procedures performed on the same day.
13. Modifier XE: Separate encounter. Use this modifier to indicate that the laser treatment was performed during a separate encounter from other services provided on the same day.
14. Modifier XP: Separate practitioner. Use this modifier to indicate that the laser treatment was performed by a different practitioner than other services provided on the same day.
15. Modifier XU: Unusual non-overlapping service. Use this modifier to indicate that the laser treatment was distinct because it does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the laser treatment was performed, ensuring accurate billing and reimbursement.
CPT code 96920, which pertains to laser treatment of skin less than 250 square centimeters, is reimbursed by Medicare under specific conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, it is crucial to consult the local coverage determinations (LCDs) provided by the Medicare Administrative Contractor (MAC) for your region, as these contractors have the authority to establish coverage guidelines and reimbursement criteria for specific services.
By reviewing both the MPFS and the relevant MAC guidelines, providers can ascertain the reimbursement status and any specific requirements or limitations associated with CPT code 96920.
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 96920. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer, maximizing your revenue and streamlining your financial operations.
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
