CPT Code 22595

CPT code 22595 is a medical billing code for arthrodesis, a surgical procedure to fuse the atlas and axis vertebrae in the spine.

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What is CPT Code 22595

CPT code 22595 is for a surgical procedure called "arthrodesis, posterior technique, atlas-axis." This means it involves the fusion of the first and second cervical vertebrae (the atlas and axis) using a posterior approach. This procedure is typically done to stabilize the spine in cases of instability or severe arthritis.

Does CPT 22595 Need a Modifier?

When billing for CPT code 22595 (Arthrodesis, posterior technique, atlas-axis (C1-C2)), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 22595, 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 factors such as increased intensity, time, technical difficulty, or severity of the patient's condition.

2. Modifier 50 (Bilateral Procedure)
- Apply this modifier if the procedure was performed bilaterally. However, this is less common for this specific code as it pertains to a specific anatomical location.

3. Modifier 51 (Multiple Procedures)
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.

4. Modifier 52 (Reduced Services)
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.

5. Modifier 59 (Distinct Procedural Service)
- Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is particularly useful when the procedure is not typically reported together but is appropriate under the circumstances.

6. Modifier 62 (Two Surgeons)
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.

7. Modifier 66 (Surgical Team)
- This modifier is used when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.

8. Modifier 76 (Repeat Procedure by Same Physician)
- Apply this modifier if the same physician repeats the procedure on the same day. This indicates that the procedure was necessary to be performed again.

9. Modifier 77 (Repeat Procedure by Another Physician)
- Use this modifier when a procedure is repeated by another physician on the same day. This helps differentiate the services provided by different practitioners.

10. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period)
- This modifier is used if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.

11. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period)
- Apply this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

12. Modifier 80 (Assistant Surgeon)
- Use this modifier when an assistant surgeon is required to help with the procedure.

13. Modifier 81 (Minimum Assistant Surgeon)
- This modifier is used when a minimum assistant surgeon is required for the procedure.

14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available))
- Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.

15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery)
- Use this modifier when a non-physician provider assists in the surgery.

Each modifier serves a specific purpose and should be used accurately to reflect the services provided and ensure proper reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.

CPT Code 22595 Medicare Reimbursement

Medicare reimbursement for CPT code 22595, which refers to "Arthrodesis, posterior technique, atlas-axis (C1-C2)," is subject to specific criteria and guidelines. Generally, Medicare does reimburse for this procedure if it is deemed medically necessary and meets the established coverage criteria. The reimbursement amount can vary based on geographic location, the specific Medicare Administrative Contractor (MAC), and other factors such as facility type.

As of the most recent data, the national average reimbursement rate for CPT code 22595 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,500 to $2,000. However, it is crucial to verify the exact reimbursement rate with the local MAC and ensure that all documentation and medical necessity requirements are met to secure proper reimbursement.

For the most accurate and up-to-date information, healthcare providers should consult the Medicare Fee Schedule Lookup Tool or contact their local MAC.

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