Medicare Coverage for Cosmetic Surgery

PQRS Cosmetic surgery or expenses incurred in connection with such surgery is not covered. PQRS Cosmetic surgery includes any surgical procedure directed at improving appearance, except when required for the prompt (i.e., as soon as medically feasible) repair of accidental injury or for the improvement of the functioning of a malformed body member. For example, this exclusion does not apply to surgery in connection with treatment of severe burns or repair of the face following a serious automobile accident, or to surgery for therapeutic purposes which coincidentally also serves some cosmetic purpose.

For more information please visit “Billing and Coding Guidelines for Cosmetic Services“.

CPT Codes For Repair Procedures On The Lips

Below is a list summarizing the CPT codes for repair procedures on the lips. CPT Code 40650 CPT 40650 describes the repair of the vermilion only of the lip with full thickness. CPT Code 40652 CPT 40652 describes the repair of a full-thickness lip up to half its vertical height. CPT Code 40654 CPT 40654…

(2023) Modifier 59 | Distinct Procedural Service

Modifier 59 is used for Distinct Procedural Services. Multiple services provided to a patient on one day by the same provider may appear to be incorrectly coded, when in fact the services may have been performed as reported. Because these circumstances cannot be easily identified modifier 59 was established to permit claims of such a…

How To Use CPT Code 99442

CPT 99442 is a code for telephone evaluation and management services provided by a physician or other qualified health care professional to an established patient, parent, or guardian. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99442. 1. What is…

CPT Code 90999

Official Description: “Unlisted dialysis procedure, inpatient or outpatient”. How to use CPT 90999: You can use CPT 90999 to report dialysis services or procedures that are not specified otherwise. Clinical responsibility: The provider performs a dialysis service or procedure not represented by any standard and active CPT® codes available. Code: P9A Description: DIALYSIS SERVICES (MEDICARE…

President Trump to replace Obamacare

President Trump called on Democrats and Republicans to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs, and provider better healthcare. “Mandating every American to buy government-approved health insurance was never the right solution for our country,” Trump said. “The way to make health insurance available to everyone is to lower…

Hospital Visits and Critical Care on a same day

Physicians and qualified NPPs should note the payment policy requirements for CPT codes 99221 – 99239 when submitted with Critical care CPT codes 99291 – 99292 When a hospital inpatient or office/outpatient evaluation and management (E/M) service is furnished on a calendar date at which time the patient does not require critical care and the…

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