CPT Code 20932

CPT code 20932 is for osteoarticular allograft with surface and bone.

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What is CPT Code 20932

CPT code 20932 is used for a procedure involving an osteoarticular allograft with surface and bone. This means that the healthcare provider is transplanting bone and cartilage from a donor to a recipient, typically to repair or replace damaged joint surfaces and underlying bone.

Does CPT 20932 Need a Modifier?

For CPT code 20932 (Osteoarticular allograft, with or without other metallic or non-metallic implant; surfaces and/or segments), the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could apply if the osteoarticular allograft procedure is more complex or time-consuming than usual.

2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. If CPT 20932 is performed along with other procedures, this modifier may be necessary.

3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used if the osteoarticular allograft is part of a planned, staged series of procedures.

4. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day. This could be relevant if CPT 20932 is performed in conjunction with other procedures that are not typically performed together.

5. Modifier 76 - Repeat Procedure or Service by Same Physician: Used if the same procedure needs to be repeated by the same physician. This could apply if the osteoarticular allograft needs to be performed again due to complications or other reasons.

6. Modifier 77 - Repeat Procedure by Another Physician: Used if the procedure is repeated by a different physician. This might be relevant in a multi-specialty practice or hospital setting.

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: Used if the patient needs 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: Used if the osteoarticular allograft is performed during the postoperative period of another, unrelated procedure.

9. Modifier 80 - Assistant Surgeon: Used if an assistant surgeon is required during the procedure.

10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used if an assistant surgeon is necessary and a qualified resident surgeon is not available.

11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used if a non-physician provider assists in the surgery.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.

CPT Code 20932 Medicare Reimbursement

Medicare reimbursement for CPT code 20932, which pertains to osteoarticular allograft with surface and bone, can vary based on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed, and the patient's specific circumstances. Generally, Medicare does provide reimbursement for this code, but the exact amount can differ.

To determine the precise reimbursement amount for CPT code 20932, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or the relevant MAC's fee schedule. Additionally, it is advisable to verify coverage and reimbursement specifics through the Medicare Coverage Database or by contacting the MAC directly.

For the most accurate and up-to-date information, providers should also consider using tools like the CMS Physician Fee Schedule Look-Up Tool, which can provide detailed payment information based on geographic location and other variables.

Are You Being Underpaid for 20932 CPT Code?

Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. For instance, if you're billing for CPT code 20932 (Osteoart algrft w/surf & b1), RevFind ensures you're receiving the correct reimbursement. Schedule a demo today to see how RevFind can optimize your revenue cycle and safeguard your practice's financial health.

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