CPT code 55705 is used for an incisional prostate biopsy, detailing the specific procedure for accurate documentation and reimbursement.
CPT code 55705 is used to describe a medical procedure involving the biopsy of the prostate. This code specifically refers to an incisional biopsy, which means that a sample of prostate tissue is obtained through a surgical incision. The procedure can be performed using any surgical approach deemed appropriate by the healthcare provider. This code is essential for accurately documenting and billing for the procedure, ensuring that healthcare providers are reimbursed for the services they provide.
For CPT code 55705, which pertains to a prostate biopsy, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if 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 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, such as when a physician interprets the results of the biopsy but does not perform the procedure.
3. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the prostate, this modifier indicates that the procedure was bilateral.
4. Modifier 51 - Multiple Procedures: Use this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
5. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 53 - Discontinued Procedure: If the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier should be applied.
7. 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.
8. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate the repeat service.
9. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician.
10. 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 returns to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required and a qualified resident surgeon is not available.
15. Modifier 99 - Multiple Modifiers: If multiple modifiers are applicable, this modifier indicates that more than one modifier is being used.
These modifiers should be applied based on the specific circumstances of the procedure and the documentation provided. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 55705 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 55705 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether and how much Medicare reimburses for this particular procedure. Healthcare providers should consult their specific MAC for detailed information on reimbursement rates and any additional requirements that may apply.
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