CPT Code 20955

CPT code 20955 is a medical code used to describe a microvascular fibula bone graft procedure for billing and documentation purposes.

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What is CPT Code 20955

CPT code 20955 is for a surgical procedure where a piece of the fibula bone is taken and used as a graft, with the blood vessels (microvasculature) also being transferred to ensure the graft remains viable. This is often done to repair or reconstruct other bones or tissues in the body.

Does CPT 20955 Need a Modifier?

For CPT code 20955 (Fibula bone graft microvascular), 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 perform the procedure is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the surgery.

2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.

3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the fibula bone graft is one of several procedures.

4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.

5. Modifier 53 - Discontinued Procedure: Used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.

6. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day. This is particularly relevant if the fibula bone graft is performed in conjunction with other procedures that are not typically performed together.

7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of the procedure.

8. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure due to its complexity.

9. Modifier 76 - Repeat Procedure by Same Physician: Used if the same physician needs to repeat the procedure on the same day.

10. Modifier 77 - Repeat Procedure by Another Physician: Used if a different physician needs to repeat the procedure on the same day.

11. 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.

12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required to help with the procedure.

14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.

15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required because a qualified resident surgeon is not available.

16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these healthcare professionals assist in the surgery.

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

CPT Code 20955 Medicare Reimbursement

Medicare reimbursement for CPT code 20955, which pertains to a fibula bone graft with microvascular anastomosis, depends on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed, and the medical necessity as documented in the patient's medical records.

Generally, Medicare does reimburse for CPT code 20955 when the procedure is deemed medically necessary. However, the reimbursement amount can vary. As of the latest available data, the national average reimbursement rate for CPT code 20955 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,500 to $2,000. This amount can fluctuate based on geographic adjustments and other factors.

For the most accurate and up-to-date reimbursement information, healthcare providers should consult the Medicare Fee Schedule for their specific locality or contact their MAC directly. Additionally, verifying coverage criteria and ensuring thorough documentation of medical necessity are crucial steps to secure reimbursement for this procedure.

Are You Being Underpaid for 20955 CPT Code?

Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 20955 for fibula bone graft microvasc, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.

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