CPT Code 67350

CPT code 67350 is a medical code for billing the biopsy of an eye muscle.

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What is CPT Code 67350

CPT code 67350 is designated for a surgical procedure involving the biopsy of an eye muscle. This code is used by healthcare providers to bill for the specific service of obtaining a tissue sample from one of the muscles surrounding the eye, which is then typically analyzed for diagnostic purposes.

Does CPT 67350 Need a Modifier?

For CPT code 67350, which pertains to a biopsy of eye muscle, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is an ordered list of potential modifiers and the reasons for their use:

1. -26 (Professional Component): This modifier is used when only the professional component of the procedure is being billed, meaning the service provided by the physician, excluding any facility or equipment usage.

2. -50 (Bilateral Procedure): If the biopsy is performed on muscles of both eyes during the same operative session, this modifier should be applied to indicate a bilateral procedure.

3. -51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session by the same provider. It helps in adjusting the reimbursement for the additional procedures, which are generally paid at a reduced rate.

4. -52 (Reduced Services): This modifier is applicable if the procedure is partially reduced or eliminated at the physician’s discretion. It indicates that a service or procedure was partially performed and can affect reimbursement.

5. -53 (Discontinued Procedure): Applied when a procedure is terminated after the beginning but before completion due to extenuating circumstances or those that threaten the well-being of the patient.

6. -54 (Surgical Care Only): When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, this modifier is used by the surgeon who performed the procedure.

7. -55 (Postoperative Management Only): Used by a physician who provides postoperative management but did not perform the surgical procedure.

8. -56 (Preoperative Management Only): Used when one physician performed the preoperative care and evaluation and another performed the surgical procedure.

9. -57 (Decision for Surgery): Added to the CPT code when the decision to perform the major surgical procedure is made during an E/M service that occurred a day before or the day of the surgery.

10. -59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to signify that a procedure or service was separate and necessary at the time of surgery.

11. -78 (Unplanned Return to the Operating/Procedure Room): Used when a patient returns to the operating or procedure room for a related procedure during the postoperative period.

12. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a new or unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

13. -80 (Assistant Surgeon): Used when an assistant surgeon is present to help the primary surgeon during the eye muscle biopsy.

14. -82 (Assistant Surgeon - when qualified resident surgeon not available): Similar to -80, but specifically used when a qualified resident surgeon is not available to assist.

15. -AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): Used specifically when a PA, NP, or CNS serves as the assistant during the surgery.

Each modifier provides specific information that affects how billing and reimbursement are handled, ensuring accurate and fair payment for services rendered. It’s crucial to select the appropriate modifier(s) based on the specific details of the procedure and the roles of the healthcare providers involved.

CPT Code 67350 Medicare Reimbursement

CPT code 67350, which pertains to a biopsy of the eye muscle, is generally reimbursable by Medicare. However, the reimbursement for this procedure can vary based on several factors including the geographic location of the service provider, the setting in which the procedure is performed (such as inpatient hospital, outpatient hospital, or a physician's office), and the specifics of the patient's Medicare plan.

To determine the exact reimbursement amount for CPT code 67350, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. This schedule provides detailed information on the reimbursement rates for all CPT codes based on the locality. Additionally, providers should ensure that the documentation supports the medical necessity of the procedure to facilitate appropriate reimbursement.

It is also important to check with local Medicare Administrative Contractors (MACs) as they may have specific guidelines or coverage determinations that affect how this procedure is reimbursed in different regions.

Are You Being Underpaid for 67350 CPT Code?

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