CPT code 38213 is a medical code used to describe the procedure of harvesting platelet-depleted blood for transfusion or treatment purposes.
CPT code 38213 is used for the process of removing platelets from a harvested blood sample.
For CPT code 38213, which involves the platelet depletion of a harvest, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation or supervision of the procedure, rather than the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the equipment, supplies, and technical support involved in the procedure.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to prevent bundling of services that are typically considered part of a single procedure.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day. It indicates that the repeat procedure was necessary and not due to an error in the initial procedure.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It indicates that the repeat procedure was necessary and not due to an error in the initial procedure.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a laboratory test is repeated on the same day to obtain subsequent (multiple) test results. It is applicable if the test is necessary for the patient's treatment.
These modifiers help provide additional information about the service provided and ensure accurate billing and reimbursement. It is important to use them appropriately to avoid claim denials or delays.
CPT code 38213, which involves platelet depletion of harvest, is subject to reimbursement considerations under Medicare. To determine if this specific CPT code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with their corresponding reimbursement rates.
Additionally, it is crucial to consult with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on whether CPT code 38213 is covered and reimbursed in your area. They may also offer insights into any local coverage determinations (LCDs) that could affect reimbursement for this service.
In summary, while the MPFS and MACs are key resources for determining Medicare reimbursement for CPT code 38213, providers should verify the most current information through these channels to ensure accurate billing and reimbursement.
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