CPT Code 66130

CPT code 66130 is for the surgical removal of an eye lesion.

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What is CPT Code 66130

CPT code 66130 is designated for the surgical procedure involving the excision of a lesion from the eye. This code is used specifically when a lesion, which could be any abnormal growth or tissue, is surgically removed from the sclera or cornea of the eye. The procedure is typically performed by an ophthalmologist to address issues that may impair vision or cause discomfort to the patient.

Does CPT 66130 Need a Modifier?

For the CPT code 66130, which pertains to the excision of an eye lesion, several modifiers may be applicable depending on the specific circumstances of the procedure. Here’s an ordered list of potential modifiers and the reasons for their use:

1. -RT (Right Side) and -LT (Left Side): These modifiers are used to indicate which eye the procedure was performed on. Since eye procedures are specific to each eye, specifying the side is crucial for accurate billing and medical records.

2. -50 (Bilateral Procedure): If the procedure is performed on lesions in both eyes during the same operative session, this modifier should be used. It's important for reimbursement purposes as some payers may adjust the payment for bilateral procedures.

3. -51 (Multiple Procedures): This modifier is used when multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (e.g., vaccines), are performed at the same session by the same provider. It may be necessary if the excision of the eye lesion is one of several procedures performed.

4. -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. This could be applicable if the excision of the eye lesion is performed in conjunction with other, non-related procedures that are not normally reported together.

5. -76 (Repeat Procedure by Same Physician): If the excision needs to be repeated in the same session due to specific clinical reasons, this modifier would be appropriate.

6. -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 if a return to the operating room is required to address a complication or related issue from the initial excision.

7. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If an additional, unrelated procedure is performed by the same physician during the postoperative period of the initial excision, this modifier should be used.

Each of these modifiers serves to provide clear, specific information that affects how billing and payments are processed, ensuring that the healthcare provider is reimbursed correctly for the services provided. Always check with specific payer policies as the applicability of modifiers can vary.

CPT Code 66130 Medicare Reimbursement

CPT code 66130, which pertains to the surgical removal of an eye lesion, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location of the service provider, the setting in which the procedure is performed (e.g., hospital outpatient department vs. an ambulatory surgical center), and the Medicare Administrative Contractor (MAC) policies for that region.

To determine the exact reimbursement amount, it is advisable for healthcare providers to consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information about the reimbursement rates for specific CPT codes based on the locality. Additionally, providers should verify coverage and payment details with their local MAC to ensure compliance with any specific documentation or procedural requirements that may affect the reimbursement for this procedure.

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