CPT Code 20937

CPT code 20937 is for an additional procedure involving the use of morselized bone grafts in spinal surgery.

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What is CPT Code 20937

CPT code 20937 is used for a surgical procedure involving the use of a morselized allograft or autograft bone graft. This code is an add-on, meaning it is used in conjunction with another primary procedure to indicate that additional bone material was grafted to aid in the healing or structural support of the surgical site.

Does CPT 20937 Need a Modifier?

For CPT code 20937 (Sp bone agrft morsel add-on), the following modifiers may be applicable:

1. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. Since 20937 is an add-on code, it is typically exempt from this modifier, but it's important to verify payer-specific guidelines.

2. 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. It may be necessary if the bone grafting is performed in a different anatomical site or for a different reason than other procedures.

3. Modifier 62 (Two Surgeons): If two surgeons are required to perform distinct parts of the same procedure, this modifier may be used. Each surgeon should document their specific part of the procedure.

4. Modifier 66 (Surgical Team): This modifier is used when a complex procedure requires the skills of a surgical team. Documentation should support the necessity of a team approach.

5. Modifier 76 (Repeat Procedure by Same Physician): If the same physician needs to perform the procedure again on the same day, this modifier should be used to indicate the repeat service.

6. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a different physician performs the same procedure on the same day.

7. Modifier 78 (Unplanned Return to the Operating Room): If the patient requires an unplanned return to the operating room for a related procedure during the postoperative period, this modifier should be used.

8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when the procedure is unrelated to the original surgery and is performed by the same physician during the postoperative period.

9. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, this modifier should be used to indicate their involvement.

10. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.

11. 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.

12. 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 modifier serves a specific purpose and should be used according to the specific circumstances of the procedure and payer guidelines. Proper documentation is essential to support the use of any modifier.

CPT Code 20937 Medicare Reimbursement

Medicare reimbursement for CPT code 20937, which pertains to "Sp bone agrft morsel add-on," is subject to specific guidelines and conditions. As an add-on code, 20937 is typically reimbursed when it is billed in conjunction with a primary procedure. Medicare generally covers this code when it is deemed medically necessary and is performed as part of a covered surgical procedure.

The reimbursement amount for CPT code 20937 can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and the facility where the procedure is performed. As of the latest available data, the national average reimbursement rate for CPT code 20937 is approximately $300. However, it is essential to verify the exact reimbursement rate with the relevant MAC and consider any updates to the Medicare Physician Fee Schedule (MPFS).

Healthcare providers should ensure proper documentation and adherence to Medicare guidelines to facilitate appropriate reimbursement for this add-on code.

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