CPT Code 67550

CPT code 67550 is a medical billing code for the surgical insertion of an eye socket implant.

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What is CPT Code 67550

CPT code 67550 is designated for the surgical procedure involving the insertion of an eye socket implant. This code is used to bill for the specific operation where an implant is placed into the eye socket, typically after an enucleation or evisceration, to provide volume and support for cosmetic or functional reasons.

Does CPT 67550 Need a Modifier?

For CPT code 67550, which involves the insertion of an eye socket implant, 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. -22 (Increased Procedural Services): This modifier is used if the service provided is significantly greater than typically required. For example, if the surgery involves extra work due to scar tissue or other complications.

2. -51 (Multiple Procedures): Use this modifier if the insertion of the eye socket implant is performed at the same time as other distinct procedures. It helps in adjusting the reimbursement for multiple procedures performed during the same surgical session.

3. -52 (Reduced Services): If the procedure is partially reduced or eliminated at the physician's discretion, this modifier should be applied to indicate that a service was less extensive than usually required.

4. -53 (Discontinued Procedure): Applied when a procedure is terminated after the beginning due to extenuating circumstances or those threatening the well-being of the patient.

5. -54 (Surgical Care Only): When one physician performs the surgical care and another provides preoperative and/or postoperative management, this modifier is used.

6. -55 (Postoperative Management Only): Used when one physician performs the postoperative management and another physician performed the surgical procedure.

7. -56 (Preoperative Management Only): Indicates that a physician performed only the preoperative care when another physician performed the surgery.

8. -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a staged or related procedure is performed during the postoperative period of the initial procedure.

9. -59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day.

10. -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 return to the operating room is required for a complication related to the initial procedure.

11. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when a new or unrelated procedure is performed by the same physician during the postoperative period of the previous procedure.

12. -80 (Assistant Surgeon): Used when an assistant surgeon is present to aid the primary surgeon during the procedure.

13. -AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used specifically for non-physician practitioners who assist in surgery.

Each of these modifiers addresses specific circumstances that might affect billing and should be selected based on the details of how the procedure was performed and who was involved. Proper use of these modifiers ensures accurate billing and reimbursement for services rendered.

CPT Code 67550 Medicare Reimbursement

CPT code 67550, which pertains to the insertion of an eye socket implant, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location where the service is provided, the setting (inpatient or outpatient), and the Medicare Administrative Contractor (MAC) policies that apply to the region.

To determine the exact reimbursement amount for CPT code 67550, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC. This will provide the most accurate and up-to-date information regarding reimbursement rates for this specific procedure under Medicare. Additionally, it's important to ensure that all documentation and coding practices meet Medicare's requirements to facilitate appropriate reimbursement.

Are You Being Underpaid for 67550 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize your contracts and identify discrepancies down to specific CPT codes, such as 67550 for inserting an eye socket implant, RevFind ensures that each claim is fully compensated according to the terms agreed with individual payers. Schedule a demo today to see how RevFind can secure the payments you rightfully deserve and streamline your billing processes.

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