CPT Code 21495

CPT code 21495 is for treating a hyoid bone fracture. It helps healthcare providers standardize and streamline billing for this specific procedure.

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What is CPT Code 21495

CPT code 21495 is used for the treatment of a hyoid bone fracture. The hyoid bone is a small, U-shaped bone in the neck that supports the tongue and its muscles. This code indicates that a healthcare provider has performed a procedure to repair or treat a fracture of this bone.

Does CPT 21495 Need a Modifier?

When billing for CPT code 21495, which is used for the treatment of a hyoid bone fracture, it is essential to consider the appropriate modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 21495, along with the reasons for their use:

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 unusual circumstances.

2. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same surgical session. This helps indicate that more than one procedure was carried out.

3. Modifier 52 (Reduced Services): Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This indicates that the full service described by the CPT code was not performed.

4. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is particularly useful when billing for procedures that are not typically reported together but were performed under special circumstances.

5. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure was repeated by the same physician on the same day. This helps to clarify that the repeat procedure was necessary.

6. Modifier 77 (Repeat Procedure by Another Physician): Apply this modifier if the procedure was repeated by a different physician on the same day. This indicates that the repeat procedure was performed by another provider.

7. 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 had to return to the operating room for a related procedure during the postoperative period.

8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used if an unrelated procedure or service was performed by the same physician during the postoperative period of the initial procedure.

9. Modifier 80 (Assistant Surgeon): Apply this modifier if an assistant surgeon was required to help with the procedure. This indicates that another surgeon assisted in the operation.

10. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if a minimum assistant surgeon was required for the procedure. This indicates that the assistance was minimal but necessary.

11. 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 was not available.

12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.

By using the appropriate modifiers, healthcare providers can ensure that their claims for CPT code 21495 are accurately processed and reimbursed, reflecting the complexity and specifics of the services provided.

CPT Code 21495 Medicare Reimbursement

When determining if a specific CPT code, such as 21495 for treating a hyoid bone fracture, is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the Local Coverage Determinations (LCDs) provided by Medicare Administrative Contractors (MACs).

For CPT code 21495, Medicare does provide reimbursement, but the exact amount can vary based on geographic location and other factors. As of the latest update, the national average reimbursement for CPT code 21495 is approximately $1,200. However, this figure can fluctuate, so it is advisable to verify the current reimbursement rate through the MPFS or your local MAC.

Healthcare providers should also ensure that the procedure meets all Medicare coverage criteria and documentation requirements to avoid claim denials.

Are You Being Underpaid for 21495 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 21495 for treating hyoid bone fractures. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.

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