CPT Code 67218

CPT code 67218 is used for billing the treatment of a retinal lesion.

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What is CPT Code 67218

CPT code 67218 is used to denote a specific medical procedure involving the treatment of a retinal lesion. This code is applied when a healthcare provider performs a treatment to address abnormalities in the retina, which may involve the use of laser surgery, photocoagulation, or other therapeutic techniques aimed at preserving or improving vision affected by the lesion.

Does CPT 67218 Need a Modifier?

For the CPT code 67218, which pertains to the treatment of a retinal lesion, several modifiers may be applicable depending on the specific circumstances of the treatment provided. Here is an ordered list of potential modifiers and the reasons for their use:

1. -LT (Left side): Used to indicate that the procedure was performed on the left eye.
2. -RT (Right side): Used to indicate that the procedure was performed on the right eye.
3. -50 (Bilateral procedure): Applied when the procedure is performed on both eyes during the same operative session.
4. -26 (Professional component): This modifier is used when only the professional component of the procedure is being billed, which is applicable if the physician is only responsible for the supervision and interpretation of the procedure, not the use of equipment or facilities.
5. -TC (Technical component): Used when only the technical component of the procedure is being billed. This is relevant if the physician is billing for the use of equipment and technical staff but not for the professional interpretation.
6. -59 (Distinct procedural service): Indicates that the procedure was distinct or independent from other services performed on the same day. This modifier is used to signify that the procedure was separate and necessary at the time of treatment.
7. -76 (Repeat procedure by same physician): Used if the procedure was repeated by the same physician on the same day, which might occur if initial treatment was deemed insufficient or incomplete.
8. -77 (Repeat procedure by another physician): Applied when the procedure is repeated by a different physician on the same day, under circumstances similar to those requiring modifier -76.

Each of these modifiers provides specific billing information that helps in the accurate processing and reimbursement of claims related to the treatment of retinal lesions. It is crucial for healthcare providers to use the correct modifiers to ensure compliance with billing regulations and to facilitate appropriate payment for services rendered.

CPT Code 67218 Medicare Reimbursement

The CPT code 67218, which pertains to the treatment of a retinal lesion, is generally reimbursable by Medicare. However, the specific reimbursement amount 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, physician's office), and the Medicare Administrative Contractor (MAC) policies for the region.

To determine the exact reimbursement amount for CPT code 67218, healthcare providers should 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 applicable to specific services for any given locality.

Additionally, it's important for providers to ensure that the documentation supports the medical necessity of the procedure, as this is a critical factor in securing reimbursement from Medicare. Providers should also be aware of any National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs) that might affect coverage for this procedure.

Are You Being Underpaid for 67218 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. RevFind is adept at reading your contracts and pinpointing discrepancies down to the CPT code level, including specific codes like 67218 for the treatment of retinal lesions. This precision allows you to ensure that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for services rendered.

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