Email this page

Modifiers indicate that a service was altered in some way from the stated CPT descriptor without changing the definition. The American Medical Association (AMA) CPT modifiers are two-digit numeric codes listed after a procedure code and separated from the CPT code by a hyphen. The following CPT modifiers may be relevant to the IDET◊ procedure:

Medicare reimburses for hospital outpatient services under a prospective payment system (PPS). The system is based on Ambulatory Payment Classifications, or APCs, which are groups of procedures, medical visits and ancillary services.

• The services within each group are similar clinically and in relative resource use.
• Payment under the hospital outpatient PPS depends on what item or service is furnished to a patient and to what APC that item or service is grouped.
• Cases are assigned to an APC group based on the CPT and HCPCS codes reported by the facility.
• For an update on APC codes for the IDET◊ procedure, see APC Changes.

Procedure codes indicate the surgical and/or diagnostic procedures performed on the patient. Hospital outpatient/inpatient claims must report the appropriate ICD-9-CM procedure codes. The following ICD-9-CM procedure code may apply to patients undergoing IDET◊:

ICD-9	Description	CPT Cross Reference
80.59	OTH EXC/DEST INTVRT DISC	0062T, 0063T, 64999

Private insurers cover hospital outpatient services that are considered medically necessary and within the benefit structure of the patient’s health insurance coverage.

• Payment for the IDET◊ procedure may be based on a percentage of the billed or allowed charges, per diem, or on a negotiated payment rate.
• Check with your payor organizations to determine the payment methodology for the IDET◊ procedure.

For further help with insurance and reimbursement, use our Reimbursement Calculation Tools.