CPT code 38220 is used to identify procedures for bone marrow aspirations, helping healthcare providers document and communicate specific services rendered.
CPT code 38220 is used to bill for a diagnostic procedure involving bone marrow aspirations, where a sample is collected from the bone marrow to help diagnose various conditions.
For CPT code 38220, which pertains to diagnostic bone marrow aspirations, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component only, such as the interpretation of the results by a physician.
2. Modifier TC - Technical Component: This modifier is used when the service provided is the technical component only, such as the use of equipment and supplies for 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 may be necessary if multiple procedures are performed that are not typically reported together.
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.
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.
6. 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 returns to the operating room for a related procedure during the postoperative period.
7. 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.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent test results.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 38220 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered under Medicare Part B, and it is updated annually to reflect changes in policy and practice costs.
To determine the exact reimbursement rate for CPT code 38220, healthcare providers should refer to the MPFS, which details the allowable charges for each service. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and ensuring compliance with Medicare policies. MACs may have local coverage determinations (LCDs) that provide further guidance on the circumstances under which CPT code 38220 is reimbursable. Therefore, it is essential for healthcare providers to consult both the MPFS and their respective MACs to ensure accurate billing and reimbursement for this service.
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