CPT Code 21620

CPT code 21620 is for the partial removal of the sternum, a procedure often necessary in specific medical treatments or surgeries.

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What is CPT Code 21620

CPT code 21620 is for the partial removal of the sternum. This procedure involves surgically removing a portion of the sternum, which is the bone located in the center of the chest. This may be necessary for various medical reasons, such as to access underlying organs or to remove diseased or damaged tissue.

Does CPT 21620 Need a Modifier?

For CPT code 21620 (Partial removal of sternum), 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 sides of the body.

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 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.

8. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.

9. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when the same physician performs a procedure or service again on the same day.

10. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician on the same day.

11. 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.

12. 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.

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

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

15. 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.

16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in 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 21620 Medicare Reimbursement

When considering whether Medicare reimburses for the CPT code 21620, which pertains to the partial removal of the sternum, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) for the most accurate and up-to-date information.

As of the latest available data, CPT code 21620 is generally reimbursed by Medicare, provided that the procedure is deemed medically necessary and is performed in accordance with Medicare guidelines. The reimbursement amount can vary based on several factors, including geographic location, the setting in which the procedure is performed (e.g., hospital outpatient department, ambulatory surgical center), and any applicable modifiers.

For a precise reimbursement amount, healthcare providers should refer to the MPFS Look-Up Tool on the Centers for Medicare & Medicaid Services (CMS) website or consult their Medicare Administrative Contractor (MAC). As an example, the national average reimbursement for CPT code 21620 might be approximately $1,200, but this figure can fluctuate based on the aforementioned factors.

To ensure accurate billing and reimbursement, it is advisable to verify the specific coverage policies and reimbursement rates applicable to your practice's location and patient population.

Are You Being Underpaid for 21620 CPT Code?

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