CPT code 96936 is for cellular and subcellular imaging of the skin, used in dermatology to diagnose and monitor skin conditions.
CPT code 96936 is used for the procedure involving cellular and subcellular imaging of the skin. This code is typically utilized when advanced imaging techniques are employed to examine the skin at a microscopic level, allowing healthcare providers to diagnose and monitor various skin conditions with high precision. This can include identifying cellular abnormalities, assessing skin diseases, and evaluating treatment responses.
For CPT code 96936, 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 an E/M service is performed on the same day as the procedure and is distinct and separately identifiable from the procedure itself.
2. Modifier 26: Professional component. This modifier is used when only the professional component of the service is being billed, typically when the interpretation of the imaging is performed separately from the technical component.
3. Modifier 50: Bilateral procedure. This modifier is used when the 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 53: Discontinued procedure. This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
7. 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.
8. 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 on the same day.
9. 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 a different provider on the same day.
10. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used when the same laboratory test is performed multiple times on the same day for the same patient.
11. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used when the service is provided through telemedicine.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 96936 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS is updated annually and provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates.
Additionally, reimbursement for CPT code 96936 may vary based on the policies of the Medicare Administrative Contractor (MAC) that services your region. Each MAC has the authority to make determinations regarding coverage and reimbursement for specific CPT codes, so it is advisable to consult your local MAC for the most accurate and up-to-date information.
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