CPT code 96931 is used for cellular and subcellular imaging of the skin, aiding in the diagnosis and treatment of various skin conditions.
CPT code 96931 is used for cellular and subcellular imaging of the skin. This code is typically utilized in dermatology to describe procedures that involve detailed imaging techniques to examine the skin at a cellular or subcellular level. These advanced imaging methods help healthcare providers diagnose and monitor various skin conditions with high precision.
For CPT code 96931, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service. This modifier is used when a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
2. Modifier 26: Professional component. This modifier is used when only the professional component of the service is being billed, typically for services that have both a professional and technical component.
3. Modifier 50: Bilateral procedure. This modifier is used when the same procedure is performed on both sides of the body during the same session.
4. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same session by the same provider.
5. Modifier 52: Reduced services. This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 59: Distinct procedural service. This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used when a procedure or service is repeated by the same provider subsequent to the original procedure or service.
8. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when a procedure or service is repeated by another provider subsequent to the original procedure or service.
9. 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 when a related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. This modifier is used when an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
11. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help provide additional information about the performed service, ensuring accurate billing and reimbursement.
The CPT code 96931 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and pricing.
Additionally, reimbursement for CPT code 96931 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to interpret and implement Medicare policies within their jurisdictions. Therefore, it is advisable to consult the relevant MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 96931.
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