CPT Code 25315

CPT code 25312 is a medical code used to describe the procedure for transplanting a tendon in the forearm.

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What is CPT Code 25315

CPT code 25315 is a medical billing code used to describe the surgical procedure for revising the tendons in a hand affected by palsy. This procedure aims to improve hand function by correcting or reconstructing the tendons that have been impaired due to palsy, which is a condition that causes muscle weakness or paralysis.

Does CPT 25315 Need a Modifier?

For CPT code 25315 (Revise palsy hand tendon(s)), 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 hands during the same operative session.

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 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 another 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 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.

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

12. 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.

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

14. Modifier LT - Left Side: Used to indicate that the procedure was performed on the left side of the body.

15. Modifier RT - Right Side: Used to indicate that the procedure was performed on the right side of the body.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always refer to the latest CPT coding guidelines and payer-specific requirements for the most accurate and up-to-date information.

CPT Code 25315 Medicare Reimbursement

CPT code 25315 is reimbursed by Medicare, but the specifics of reimbursement can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 25315. To determine the exact reimbursement amount, healthcare providers should refer to the MPFS, which is updated annually.

Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement rates for CPT code 25315. Providers should consult their respective MAC for detailed guidance on billing and reimbursement for this code.

Are You Being Underpaid for 25315 CPT Code?

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