CPT code 38221 is a medical code used to identify and describe bone marrow biopsies for accurate documentation and reimbursement purposes.
CPT code 38221 is a diagnostic procedure used to obtain one or more bone marrow biopsy specimens for evaluation of hematologic conditions, malignancies, or other marrow-related disorders.
For CPT code 38221, which pertains to diagnostic bone marrow biopsies, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the professional component of the service is being billed separately from the technical component. It indicates that the provider is billing only for the interpretation of the biopsy results.
2. Modifier TC - Technical Component: This modifier is used when the technical component of the service is being billed separately. It indicates that the provider is billing only for the technical aspect of the biopsy procedure, such as the use of equipment and facilities.
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. It indicates that the procedure was necessary to be performed more than once.
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 procedure was necessary to be performed more than once by another provider.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for this specific procedure, this modifier is used when a clinical diagnostic test is repeated on the same day to obtain subsequent results. It may apply if multiple biopsies are needed for diagnostic purposes.
These modifiers are used to provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 38221 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 a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the actual reimbursement for CPT code 38221 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and have the authority to implement local coverage determinations (LCDs) that may affect the reimbursement of certain procedures, including those billed under CPT code 38221. Therefore, healthcare providers should consult their respective MAC for detailed information on coverage and reimbursement rates for this specific code.
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