CPT Code 24125

CPT code 24120 is a medical billing code for the excision or curettage of bone cysts or benign tumors in the radius.

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What is CPT Code 24125

CPT code 24125 is used to describe the surgical procedure for the excision or curettage of a bone cyst or benign tumor in the radius or ulna, which are the bones of the forearm. This code specifically indicates that the procedure involves the removal of abnormal growths or cysts that are not cancerous, ensuring that the affected bone area is treated to prevent further complications.

Does CPT 24125 Need a Modifier?

When billing for CPT code 24125 (Excision or curettage of bone cyst or benign tumor of the radius or ulna), the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the substantial additional work.

2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both the radius and ulna, this modifier indicates that the procedure was performed bilaterally.

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: 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: If the same procedure is repeated by the same physician, this modifier should be used.

7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier should be applied.

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: Use this modifier if the patient needs 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: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

10. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left side of the body.

11. Modifier RT - Right Side: Use this modifier to specify that the procedure was performed on the right side of the body.

12. Modifier 99 - Multiple Modifiers: If more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are being used.

Each of these modifiers serves a specific purpose and should be used in accordance with the clinical scenario and payer guidelines to ensure accurate billing and reimbursement.

CPT Code 24125 Medicare Reimbursement

CPT code 24125 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 24125. To determine the exact reimbursement rate for this code, healthcare providers should refer to the MPFS, which is updated annually.

Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining local coverage decisions. Each MAC may have specific guidelines and policies that can affect the reimbursement of CPT code 24125. Therefore, it is essential for healthcare providers to consult their respective MAC for detailed information on coverage and reimbursement rates for this specific CPT code.

Are You Being Underpaid for 24125 CPT Code?

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