CPT Code 20979

CPT code 20979 is for the use of bone stimulation, a procedure to promote bone healing and growth.

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What is CPT Code 20979

CPT code 20979 is for the use of bone stimulation. This code is used when a healthcare provider applies a device or technique to stimulate bone growth, often in cases where bone healing is delayed or needs to be enhanced. This can be particularly useful in treating fractures or after certain types of surgeries.

Does CPT 20979 Need a Modifier?

For CPT code 20979 (Use of bone growth stimulator for spine surgery), 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 bone stimulation procedure was significantly more complex or time-consuming than usual.

2. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This might be relevant if the bone stimulation was only partially completed.

3. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This could be necessary if the bone stimulation was performed in a separate session or anatomical site from other procedures.

4. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician. This might be applicable if the bone stimulation needed to be repeated within a short period.

5. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician. This could be relevant if another healthcare provider had to perform the bone stimulation again.

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 needs to return 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: Used if the bone stimulation is performed during the postoperative period of another procedure but is unrelated to the initial surgery.

8. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure. This might be necessary if the bone stimulation procedure required additional surgical assistance.

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

10. 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.

11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.

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

CPT Code 20979 Medicare Reimbursement

Medicare does provide reimbursement for CPT code 20979, which pertains to the use of bone stimulation. However, the reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC) overseeing the claim, and the setting in which the service is provided (e.g., hospital outpatient, physician office).

As of the most recent data, the national average reimbursement rate for CPT code 20979 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,200. It is important to verify the exact reimbursement rate with your local MAC and ensure that all necessary documentation and medical necessity criteria are met to secure proper reimbursement.

Are You Being Underpaid for 20979 CPT Code?

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