CPT Code 20974

CPT code 20974 is for electrical bone stimulation, a procedure used to promote bone healing through electrical impulses.

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What is CPT Code 20974

CPT code 20974 is for electrical bone stimulation. This procedure involves using electrical currents to promote bone growth and healing, typically used for fractures or bone conditions that are not healing properly on their own.

Does CPT 20974 Need a Modifier?

For CPT code 20974 (Electrical bone stimulation), 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 more work than typically required. This could be due to the complexity of the patient's condition or other factors that necessitate additional effort.

2. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This indicates that the service provided was less than what is typically required for CPT code 20974.

3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly relevant if multiple procedures are performed and need to be billed separately.

4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same physician performs the procedure more than once on the same day. It indicates that the repeat procedure was necessary and not a duplicate billing.

5. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if a different physician performs the same procedure on the same day. This helps differentiate between services provided by different healthcare providers.

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: Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.

7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the procedure is unrelated to the original surgery and is performed during the postoperative period of the initial procedure.

8. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required for the procedure. This indicates that another surgeon assisted in the procedure.

9. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if an assistant surgeon was present but only provided minimal assistance.

10. 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.

11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier when a non-physician provider assists in the surgery.

These modifiers help provide additional context and specificity to the billing for CPT code 20974, ensuring accurate and appropriate reimbursement for the services rendered.

CPT Code 20974 Medicare Reimbursement

Medicare does provide reimbursement for CPT code 20974, which pertains to electrical bone stimulation. However, the reimbursement amount can vary based on several factors, including geographic location, the specific Medicare plan, and the setting in which the service is provided. As of the latest available data, the national average reimbursement rate for CPT code 20974 is approximately $1,200. It is essential to verify the exact reimbursement rate through the Medicare Physician Fee Schedule (MPFS) or consult with your Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information.

Are You Being Underpaid for 20974 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 20974 for electrical bone stimulation. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and safeguard your revenue.

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