CPT code 38231 is a medical code used to identify the procedure of collecting stem cells for treatment or research purposes.
CPT code 38231 is used to indicate the process of collecting stem cells for later use in treatments or transplant procedures.
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For CPT code 38231, which pertains to stem cell collection, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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, not the technical component.
2. 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 when the stem cell collection is performed in conjunction with other procedures that are not typically reported together.
3. 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.
4. 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 signifies that the procedure was necessary to be performed again by another provider.
5. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although not commonly used with this CPT code, if the stem cell collection involves a laboratory test that needs to be repeated for clinical reasons, this modifier can be applied.
6. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided. It indicates that multiple circumstances apply to the procedure.
These modifiers help provide additional information about the circumstances under which the stem cell collection was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
CPT code 38231 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) that processes claims in your region. The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. However, whether CPT code 38231 is reimbursed can vary based on local coverage determinations (LCDs) set by the MAC, which may have specific guidelines or requirements for coverage. It is essential for healthcare providers to verify the reimbursement status of CPT code 38231 with their local MAC to ensure compliance with Medicare's billing and coding policies.
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