CPT code 58970 is used for procedures involving the retrieval of oocytes through follicle puncture, regardless of the method employed.
CPT code 58970 is used to describe the procedure of follicle puncture for oocyte retrieval, regardless of the method employed. This code is typically utilized in the context of assisted reproductive technologies, such as in vitro fertilization (IVF). During this procedure, a healthcare provider retrieves oocytes, or eggs, from a woman's ovaries. The process involves using a needle to puncture the ovarian follicles where the eggs are housed, allowing for their collection. This step is crucial in fertility treatments, as it provides the eggs necessary for fertilization outside the body.
For CPT code 58970, which pertains to follicle puncture for oocyte retrieval, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when the service provided is the professional component only, such as the interpretation of results, and not the technical component.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session. It indicates that the procedure is one of several performed on the same day.
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 avoid bundling issues.
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 returns 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.
The CPT code 58970, which is associated with follicle puncture for oocyte retrieval, is not typically reimbursed by Medicare. This is because services related to fertility treatments, including oocyte retrieval, are generally not covered under Medicare benefits. The Medicare Physician Fee Schedule (MPFS) does not list this code for reimbursement, as it falls outside the scope of services that Medicare considers medically necessary for the treatment of illness or injury.
However, it's important to note that coverage can sometimes vary based on specific circumstances or regional policies. Medicare Administrative Contractors (MACs), which are responsible for processing claims and making coverage determinations in their respective jurisdictions, may have specific guidelines or exceptions. Therefore, healthcare providers should consult their local MAC for any potential updates or unique coverage policies related to this CPT code.
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