CPT Code 20985

CPT code 20985 is used for computer-assisted musculoskeletal surgical procedures, aiding in precise and efficient surgeries.

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What is CPT Code 20985

CPT code 20985 is used for computer-assisted surgical navigation procedures for musculoskeletal procedures. This code is specifically for the use of computer technology to assist in the precise location and guidance during surgery on bones and joints.

Does CPT 20985 Need a Modifier?

For CPT code 20985 (Computer-assisted surgical navigational procedure for musculoskeletal procedures), the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.

2. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, such as the interpretation of the navigational data.

3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.

4. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.

5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day.

6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician needs to repeat the procedure on the same day.

7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if a different physician repeats the procedure on the same day.

8. 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.

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

10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.

11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required for the procedure.

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.

13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when these non-physician practitioners assist in the surgery.

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

CPT Code 20985 Medicare Reimbursement

When determining if a specific CPT code, such as 20985 (Computer-assisted surgical navigation procedure for musculoskeletal procedures), is reimbursed by Medicare, it's essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs).

As of the latest updates, CPT code 20985 is generally reimbursed by Medicare, but the reimbursement amount can vary based on geographic location and specific Medicare Administrative Contractor (MAC) policies. For precise reimbursement rates, healthcare providers should refer to the MPFS or contact their local MAC.

To get the most accurate and up-to-date information, providers can use the CMS Physician Fee Schedule Look-Up Tool available on the CMS website. This tool allows providers to input the CPT code and their specific locality to determine the exact reimbursement amount.

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