CPT Code 20922

CPT code 20922 is for the removal of fascia for graft, a procedure involving the extraction of connective tissue for transplantation.

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What is CPT Code 20922

CPT code 20922 is for the removal of fascia to be used as a graft. This procedure involves taking a piece of the connective tissue that surrounds muscles, blood vessels, and nerves (known as fascia) from one part of the body to use it in another area where it is needed for surgical repair or reconstruction.

Does CPT 20922 Need a Modifier?

For CPT code 20922 (Removal of fascia for graft), the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.

2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body.

3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session.

4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day.

5. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure was repeated by the same physician on the same day.

6. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the procedure was repeated by a different physician on the same day.

7. 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 if the patient had to return to the operating room for a related procedure during the postoperative period.

8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the procedure was unrelated to the original procedure and was performed during the postoperative period.

9. Modifier LT - Left Side
- Use this modifier to indicate that the procedure was performed on the left side of the body.

10. Modifier RT - Right Side
- Apply this modifier to indicate that the procedure was performed on the right side of the body.

11. Modifier 99 - Multiple Modifiers
- Use this modifier when more than four modifiers are necessary to describe the service.

Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines to ensure accurate billing and reimbursement.

CPT Code 20922 Medicare Reimbursement

Medicare reimbursement for CPT code 20922, which pertains to the removal of fascia for graft, is subject to specific guidelines and varies based on several factors, including the setting in which the procedure is performed and the patient's specific Medicare plan. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and is performed in an outpatient setting.

To determine the exact reimbursement amount, it is essential to refer to the Medicare Physician Fee Schedule (MPFS) or the Ambulatory Surgical Center (ASC) payment rates, as these rates are updated annually. As of the latest update, the national average reimbursement for CPT code 20922 under the MPFS is approximately $200, but this amount can vary based on geographic location and other factors.

For the most accurate and up-to-date information, healthcare providers should consult the current year's MPFS or contact their Medicare Administrative Contractor (MAC).

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