CPT code 38230 is a medical code used to describe the procedure of harvesting bone marrow from a donor for transplantation.
CPT code 38230 is used to document the collection of bone marrow from a donor source other than the patient, typically performed for an allogeneic transplant.
For CPT code 38230, which pertains to bone marrow harvest for allogeneic transplant, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as patient condition or complexity of the procedure.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several performed.
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.
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 when a patient requires a return 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 a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to use these modifiers appropriately to avoid claim denials or delays.
CPT code 38230 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) overseeing the region where the service is provided. The MPFS outlines the payment rates for services covered by Medicare, and CPT code 38230 must be listed there to be eligible for reimbursement. Additionally, MACs have the authority to determine local coverage decisions, which can affect whether this specific code is reimbursed. Providers should verify the current MPFS and consult their regional MAC for the most accurate and up-to-date information regarding the reimbursement status of CPT code 38230.
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