CPT Code 25071

CPT code 25071 is for the excision of a lesion on the forearm, subcutaneous, measuring up to 3 cm.

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What is CPT Code 25071

CPT code 25071 is used to describe the surgical procedure for the excision of a lesion from the forearm that is 3 centimeters or smaller in size. This code is specifically for lesions that are located in the subcutaneous tissue, which is the layer of tissue just beneath the skin. The procedure involves the careful removal of the lesion to ensure that it is completely excised while minimizing damage to the surrounding tissues.

Does CPT 25071 Need a Modifier?

For CPT code 25071 (Excision of lesion of forearm and/or wrist; subcutaneous tissue, 3 cm or greater), the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.

2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both forearms.

3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.

4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.

5. 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.

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

7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.

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: Used when a related procedure is performed during the postoperative period.

9. 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.

10. Modifier LT - Left Side: Used to specify that the procedure was performed on the left forearm.

11. Modifier RT - Right Side: Used to specify that the procedure was performed on the right forearm.

12. Modifier XS - Separate Structure: Used to indicate a service that is distinct because it was performed on a separate organ/structure.

These modifiers help provide additional information about the procedure performed and ensure accurate billing and reimbursement.

CPT Code 25071 Medicare Reimbursement

CPT code 25071 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. To determine the exact reimbursement amount and any additional requirements, healthcare providers should consult the MPFS directly.

Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and ensuring compliance with Medicare policies. Each MAC may have localized guidelines and coverage determinations that could affect the reimbursement of CPT code 25071. Therefore, it is advisable for healthcare providers to check with their respective MAC for any region-specific rules or documentation requirements that may apply to this CPT code.

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