CPT code 20694 is for the removal of a bone fixation device.
CPT code 20694 is used for the procedure of removing a bone fixation device. This code is applied when a healthcare provider surgically takes out hardware, such as screws, plates, or rods, that were previously implanted to stabilize a bone.
For CPT code 20694, which is used for the removal of a bone fixation device, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required. This could be due to complications or unusual circumstances.
2. Modifier 50 - Bilateral Procedure: If the removal of bone fixation devices is performed on both sides of the body during the same session, this modifier should be used.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier indicates that 20694 is one of several procedures.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be applied.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the removal of the bone fixation device is planned or staged as part of the original surgery.
6. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the removal of the bone fixation device was a distinct procedural service from other services performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: If the procedure needs to be repeated by the same physician, this modifier should be used.
8. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is applicable.
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: Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If the removal of the bone fixation device is unrelated to the original procedure and occurs during the postoperative period, this modifier should be used.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be applied.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances of the procedure to ensure accurate billing and reimbursement.
Medicare does reimburse for CPT code 20694, which involves the removal of a bone fixation device. The reimbursement amount can vary based on several factors, including geographic location, the setting in which the procedure is performed (e.g., hospital outpatient department, ambulatory surgical center, or physician's office), and any applicable modifiers. As of the latest available data, the national average reimbursement rate for CPT code 20694 in a physician's office setting is approximately $200-$300. However, it is essential to verify the specific reimbursement rate through the Medicare Physician Fee Schedule (MPFS) or your local Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information.
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