CPT Code 20240

CPT code 20240 is a medical code used for billing an open superficial bone biopsy procedure.

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What is CPT Code 20240

CPT code 20240 is for a procedure where a healthcare provider performs an open biopsy of a superficial bone. This means that the provider makes an incision through the skin to access and remove a small sample of bone tissue for examination. The term "superficial" indicates that the bone is close to the surface of the body, rather than deep within.

Does CPT 20240 Need a Modifier?

For CPT code 20240 (Bone biopsy, open; superficial), the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or unusual circumstances during the bone biopsy.

2. Modifier 50 - Bilateral Procedure: If the bone biopsy is performed on both sides of the body during the same session, this modifier should be used.

3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the bone biopsy is one of several procedures.

4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion. For example, if the bone biopsy was started but not completed due to unforeseen circumstances.

5. Modifier 59 - Distinct Procedural Service: Indicates that the bone biopsy is a distinct service from other procedures performed on the same day. This is used to avoid bundling issues and to clarify that the biopsy is separate and independent.

6. Modifier 76 - Repeat Procedure by Same Physician: If the bone biopsy needs to be repeated by the same physician on the same day, this modifier is used.

7. Modifier 77 - Repeat Procedure by Another Physician: If the bone biopsy is repeated by a different physician on the same day, this modifier is applicable.

8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial bone biopsy.

9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If the bone biopsy is performed during the postoperative period of another procedure but is unrelated to the initial surgery, this modifier should be used.

10. Modifier LT - Left Side: Indicates that the bone biopsy was performed on the left side of the body.

11. Modifier RT - Right Side: Indicates that the bone biopsy was performed on the right side of the body.

12. Modifier 99 - Multiple Modifiers: If more than one modifier is necessary to describe the service, this modifier is used to indicate that multiple modifiers are applicable.

Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the bone biopsy procedure.

CPT Code 20240 Medicare Reimbursement

When determining if a specific CPT code, such as 20240 (Bone biopsy open superficial), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs).

For CPT code 20240, Medicare generally provides reimbursement, but the exact amount can vary based on geographic location and other factors. As of the latest update, the national average reimbursement rate for CPT code 20240 is approximately $500. However, this amount can fluctuate, so it is advisable to check the most current MPFS or contact your Medicare Administrative Contractor (MAC) for precise and up-to-date information.

Additionally, ensure that the procedure meets all Medicare coverage criteria and documentation requirements to avoid claim denials.

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