CPT Code 20973

CPT code 20973 is a medical code used to describe a bone or skin graft procedure for the great toe.

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What is CPT Code 20973

CPT code 20973 is for a procedure involving a bone or skin graft to the great toe. This code is used when a surgeon performs a grafting procedure to repair or reconstruct the bone or skin in the great toe, often due to injury, disease, or deformity.

Does CPT 20973 Need a Modifier?

When billing for CPT code 20973 (Bone/skin graft great toe), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer guidelines. Below is a list of potential modifiers that could be used with CPT code 20973, along with the reasons for their use:

1. Modifier 50 - Bilateral Procedure
- Used if the procedure is performed on both great toes during the same session.

2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session.

3. Modifier 59 - Distinct Procedural Service
- Used to indicate that the bone/skin graft procedure is distinct or independent from other services performed on the same day.

4. Modifier 76 - Repeat Procedure by Same Physician
- Used if the same procedure is repeated by the same physician on the same day.

5. Modifier 77 - Repeat Procedure by Another Physician
- Applied if the same procedure is repeated by a different physician on the same day.

6. 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 returns to the operating room for a related procedure during the postoperative period.

7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

8. Modifier LT - Left Side
- Used to specify that the procedure was performed on the left great toe.

9. Modifier RT - Right Side
- Used to specify that the procedure was performed on the right great toe.

10. Modifier 22 - Increased Procedural Services
- Applied when the work required to perform the procedure is substantially greater than typically required.

11. Modifier 23 - Unusual Anesthesia
- Used when a procedure that usually requires no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.

12. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Used if an unrelated evaluation and management service is provided by the same physician during the postoperative period.

13. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Applied when a significant, separately identifiable evaluation and management service is performed on the same day as the procedure.

14. Modifier 57 - Decision for Surgery
- Used when an evaluation and management service results in the initial decision to perform the surgery.

By appropriately applying these modifiers, healthcare providers can ensure accurate coding and billing for CPT code 20973, thereby optimizing reimbursement and maintaining compliance with payer requirements.

CPT Code 20973 Medicare Reimbursement

Medicare reimbursement for CPT code 20973, which pertains to a bone or skin graft for the great toe, depends on several factors including the specific Medicare plan, the medical necessity of the procedure, and the setting in which the service is provided. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and performed in an outpatient setting. However, the exact reimbursement amount can vary based on geographic location and other factors.

To determine if CPT code 20973 is reimbursed by Medicare and to find the specific reimbursement amount, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or use the Medicare Administrative Contractor (MAC) resources for their specific region. Additionally, providers can use tools like the CMS Physician Fee Schedule Lookup Tool to get detailed information on reimbursement rates.

For the most accurate and up-to-date information, it is advisable to contact the local MAC or refer to the latest MPFS data.

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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 20973 for bone/skin grafts of the great toe. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.

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