CPT Code 67850

CPT code 67850 is used for billing the treatment of an eyelid lesion by a healthcare provider.

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What is CPT Code 67850

CPT code 67850 is designated for the procedure involving the treatment of an eyelid lesion. This treatment can include various methods such as excision, destruction (e.g., laser therapy, cryotherapy), or other therapeutic techniques specifically targeting lesions on the eyelid.

Does CPT 67850 Need a Modifier?

For CPT code 67850, which pertains to the treatment of an eyelid lesion, 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. -LT (Left side): Used to specify that the treatment was performed on the left eyelid.
2. -RT (Right side): Used to specify that the treatment was performed on the right eyelid.
3. -50 (Bilateral procedure): Applied when the procedure is performed on both eyelids during the same operative session.
4. -51 (Multiple procedures): Used when multiple procedures are performed during the same surgical session. This modifier helps in adjusting the reimbursement for the additional procedures.
5. -59 (Distinct procedural service): Indicates that the procedure was distinct or independent from other services performed on the same day. This modifier is crucial for separating procedures that are normally bundled but are performed in different scenarios.
6. -76 (Repeat procedure by same physician): Used if the procedure is repeated by the same physician on the same day or during the same session.
7. -79 (Unrelated procedure or service by the same physician during the postoperative period): Applicable if the eyelid lesion treatment is performed during the postoperative period of another unrelated procedure, and it is not covered under the global surgery package.
8. -XE (Separate encounter): This modifier is used to indicate that a service that is normally bundled into one payment was performed in a separate encounter on the same day.
9. -XS (Separate structure): Used to signify that the procedure was performed on a separate anatomical structure (e.g., treating lesions on different eyelids or different areas of the same eyelid).
10. -XP (Separate practitioner): Indicates that a different practitioner performed the procedure in the same session.

Each of these modifiers provides specific information that affects billing and reimbursement, ensuring accurate representation of the services provided. It's essential for healthcare providers to apply the correct modifiers to avoid claim denials and to facilitate appropriate payment.

CPT Code 67850 Medicare Reimbursement

CPT code 67850, which pertains to the treatment of an eyelid lesion, is generally reimbursable by Medicare. However, the specific coverage and reimbursement amount can vary based on factors such as the medical necessity of the procedure, the setting in which the procedure is performed (e.g., outpatient clinic, physician's office), and the geographic location of the service provider.

To determine the exact reimbursement amount for CPT code 67850 under Medicare, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. The MPFS provides detailed information on the reimbursement rates for specific procedures in different regions. Additionally, providers should ensure that the documentation supports the medical necessity of the procedure to facilitate appropriate reimbursement.

Are You Being Underpaid for 67850 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to read your contracts and identify discrepancies down to specific CPT codes, such as 67850 for treating eyelid lesions, RevFind ensures that each service rendered is reimbursed correctly according to the terms with individual payers. Schedule a demo today to see how RevFind can help secure the payments you are entitled to.

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