CPT code 38241 is a medical code used to describe the procedure of transplanting autologous hematopoietic cells from a donor.
CPT code 38241 is used to report the collection of a patient's own hematopoietic cells for later transplantation.
For CPT code 38241, which pertains to the transplantation of autologous hematopoietic cells, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 52 - Reduced Services: This modifier is applied when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.
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 identify procedures/services that are not normally reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional subsequent to the original procedure or service.
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 of the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used for repeat laboratory tests performed on the same day to obtain subsequent (multiple) test results.
These modifiers should be used in accordance with the specific guidelines and documentation requirements set forth by the payer to ensure proper billing and reimbursement. Always verify with the latest coding guidelines and payer policies as they can change over time.
CPT code 38241 is related to a specific medical procedure, and whether it is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the Medicare Administrative Contractor (MAC) for the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. If CPT code 38241 is listed on the MPFS, it indicates that Medicare has established a reimbursement rate for this code, subject to the conditions and limitations outlined in the schedule.
Additionally, MACs, which are private health insurers contracted by Medicare to process claims, play a crucial role in determining coverage and reimbursement. Each MAC may have specific Local Coverage Determinations (LCDs) that affect whether CPT code 38241 is reimbursed in their jurisdiction. These determinations can vary based on medical necessity, documentation requirements, and other local policies.
Therefore, to ascertain if CPT code 38241 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs issued by their regional MAC. This ensures compliance with Medicare's reimbursement policies and helps in accurate billing and claims processing.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 38241, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
