CPT Code 21270

CPT code 21270 is a medical code used to describe the procedure for augmenting the cheek bone.

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What is CPT Code 21270

CPT code 21270 is used for the surgical procedure of augmenting the cheek bone. This involves enhancing the size or shape of the cheek bone, typically through the use of implants or other materials, to improve facial structure and aesthetics.

Does CPT 21270 Need a Modifier?

For CPT code 21270 (Augmentation cheek bone), 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 greater effort or complexity than typically required.

2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the augmentation was performed on both cheek bones during the same operative session.

3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session.

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

5. 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.

6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure was repeated by the same physician on the same day.

7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure was repeated by a different physician 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
- Apply this modifier if the patient had 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
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period.

10. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was required for the procedure.

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

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.

13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted 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 coding guidelines and payer-specific requirements when applying modifiers.

CPT Code 21270 Medicare Reimbursement

Medicare reimbursement for CPT code 21270, which pertains to the augmentation of the cheek bone, is generally not covered. This procedure is often considered cosmetic and elective, and Medicare typically does not reimburse for cosmetic surgeries unless they are deemed medically necessary. For instance, if the augmentation is required due to a congenital defect, traumatic injury, or reconstructive surgery following a medically necessary procedure, there might be exceptions. However, these cases are evaluated on an individual basis, and prior authorization is usually required.

As for the specific reimbursement amount, it varies based on the Medicare Administrative Contractor (MAC) jurisdiction and the specific circumstances of the case. Providers should consult the latest Medicare fee schedule and their local MAC for precise information.

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