CPT Code 21260

CPT code 21260 is a medical code used to describe the surgical procedure for revising eye sockets.

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What is CPT Code 21260

CPT code 21260 is for the surgical procedure to revise or reconstruct the eye sockets. This typically involves correcting deformities or defects in the eye socket area to improve function or appearance.

Does CPT 21260 Need a Modifier?

For CPT code 21260 (Revise eye sockets), the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.

2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both eyes during the same session.

3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.

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 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 a procedure or service was distinct or independent from other services performed on the same day.

7. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.

8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician.

9. 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 when a related procedure is performed during the postoperative period of the initial procedure.

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

11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.

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

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

14. 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 of the procedure and ensure accurate billing and reimbursement.

CPT Code 21260 Medicare Reimbursement

Medicare does provide reimbursement for CPT code 21260, which pertains to the revision of eye sockets. The reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC) overseeing the claim, and whether the procedure is performed in a hospital outpatient setting or an ambulatory surgical center. As of the latest available data, the national average reimbursement for CPT code 21260 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,200. However, it is crucial to verify the exact reimbursement rate with the relevant MAC and consider any updates to the fee schedule that may affect the amount.

Are You Being Underpaid for 21260 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 21260 for revising eye sockets. 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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