CPT Code 21267

CPT code 21267 is a medical code used to describe the surgical procedure to revise or reconstruct eye sockets.

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What is CPT Code 21267

CPT code 21267 is used for the surgical procedure that involves revising or reconstructing the eye sockets. This can include correcting deformities, repairing injuries, or making adjustments to improve the fit of prosthetic eyes.

Does CPT 21267 Need a Modifier?

For CPT code 21267 (Revise eye sockets), the following modifiers may be applicable depending on the specific circumstances of the procedure:

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 eye sockets during the same operative 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 the patient requires a return to the operating room for a related procedure during the postoperative period.

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.

Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT and payer guidelines to confirm the appropriate use of modifiers.

CPT Code 21267 Medicare Reimbursement

Medicare reimbursement for CPT code 21267, which pertains to the revision of eye sockets, depends on several factors including the medical necessity of the procedure, the setting in which it is performed, and the specific Medicare Administrative Contractor (MAC) policies in your region. Generally, Medicare does cover medically necessary surgical procedures, including those involving the revision of eye sockets, provided that the documentation supports the necessity of the procedure.

To determine the exact reimbursement amount for CPT code 21267, you would need to refer to the Medicare Physician Fee Schedule (MPFS) or the Ambulatory Surgical Center (ASC) payment rates, depending on where the procedure is performed. These rates can vary by geographic location due to adjustments for local cost variations.

For the most accurate and up-to-date information, healthcare providers should consult the MPFS Look-Up Tool on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC. This will provide the specific reimbursement rate applicable to their practice location and setting.

Are You Being Underpaid for 21267 CPT Code?

Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 21267 for revising eye sockets. 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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