CPT Code 22526

CPT code 22526 is a medical billing code used to describe a single-level Intradiscal Electrothermal Annuloplasty (IDET) procedure.

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What is CPT Code 22526

CPT code 22526 is used for the procedure known as Intradiscal Electrothermal Annuloplasty (IDET) at a single spinal level. This procedure involves the use of heat to treat chronic discogenic pain by applying thermal energy to the annulus of the intervertebral disc.

Does CPT 22526 Need a Modifier?

For CPT code 22526 (IDET single level), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:

1. Modifier 50 - Bilateral Procedure
- Used when the procedure is performed on both sides of the body.

2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same session.

3. Modifier 52 - Reduced Services
- Used when the service provided is less than usually required.

4. Modifier 59 - Distinct Procedural Service
- Indicates that the procedure is distinct or independent from other services performed on the same day.

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

6. Modifier 77 - Repeat Procedure by Another Physician
- Applied when the same procedure is repeated by a different physician.

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
- Used when the patient returns 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
- Indicates that the procedure is unrelated to the original procedure performed during the postoperative period.

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

10. Modifier 81 - Minimum Assistant Surgeon
- Applied when a minimum assistant surgeon is required.

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

12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Indicates that a non-physician provider assisted in the surgery.

Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT coding guidelines and payer-specific policies for the most accurate and up-to-date information.

CPT Code 22526 Medicare Reimbursement

CPT code 22526, which refers to the percutaneous intradiscal electrothermal annuloplasty (IDET) procedure for a single level, is not reimbursed by Medicare. The Centers for Medicare & Medicaid Services (CMS) have determined that there is insufficient evidence to support the efficacy of this procedure, and therefore, it is not covered under Medicare. Consequently, there is no reimbursement amount available for CPT code 22526 under Medicare guidelines. Healthcare providers should consider alternative treatment options that are covered by Medicare for patients requiring similar interventions.

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