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21088
Quick jump to procedure code: Printer Friendly Version
21100

CPT® 21089: UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE

Short Description: Prepare face/oral prosthesis

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CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
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MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
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OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
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WISCONSIN-Entire State
WYOMING-Entire State


2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $129.29
2016 APC Code: 5161
Level 1 ENT Procedures

2016 OPPS Status Indicator: T

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Limited claims data available for this procedure.
PercentageICD-9ICD-10 Conversions
9.5% V15.59    Personal history of other injury Z87.828   Personal history of other (healed) physical injury and trauma
7.1% 146.0    Malignant neoplasm, tonsil C09.9   Malignant neoplasm of tonsil, unspecified
4.8% 145.2    Malignant neoplasm, hard palate C05.0   Malignant neoplasm of hard palate
4.8% 190.1    Malignant neoplasm of orbit C69.60   Malignant neoplasm of unspecified orbit
4.8% 524.62    Arthralgia of temporomandibular joint M26.62   Arthralgia of temporomandibular joint
4.8% 524.63    Articular disc disorder (reducing or nonreducing) M26.63   Articular disc disorder of temporomandibular joint
4.8% 527.7    Disturbance of salivary secretion K11.7   Disturbances of salivary secretion
OR:
R68.2   Dry mouth, unspecified
4.8% 738.10    Unspecified deformity of head M95.2   Other acquired deformity of head
2.4% 145.3    Malignant neoplasm, soft palate C05.1   Malignant neoplasm of soft palate
2.4% 172.0    Malignant neoplasm of lip C43.0   Malignant melanoma of lip
OR:
D03.0   Melanoma in situ of lip

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

21089 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 21089

CCI and MUE Edits*         Hide this section.


Medically Unlikely Edits for 21089

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: Not Listed Not Listed Not Listed
Adjudication Indicator: Not Listed Not Listed Not Listed
Rationale: Not Listed Not Listed Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   21089 Top 5 Ordering Providers National*
THERESA HOFSTEDE -HOUSTON,TX 50
RICHARD CARDOSO -HOUSTON,TX 32
JACK MARTIN -HOUSTON,TX 17
MARK CHAMBERS -HOUSTON,TX 17
GHASSAN SINADA -BALTIMORE,MD 14

*Based on 2013 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 21089*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 925
Total Services Denied 2014: 555 (60.0%)
National Charges Submitted 2014: $ 1,441,728.00
National Charges Allowed 2014: $ 240,156.00
National Average (No Modifier) Fee Submitted 2014: $1586.12
National Average (No Modifier) Fee Allowed 2014: $650.13


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Oral surgery
(dentists only)
608 65.7% $1585.33 334 54.9%
Maxillofacial surgery
(eff 5/92)
191 20.6% $1606.91 101 52.9%
Family practice 109 11.8% $1390.75 109 100.0%
Otolaryngology 6 0.6% $1359.50 4 66.7%
General practice 4 0.4% $919.25 4 100.0%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 481 52.0% $1286.94 365 75.9%
Outpatient hospital 440 47.6% $1864.48 186 42.3%
Inpatient hospital 2 0.2% $796.99 2 100.0%
Home 1 0.1% $ 1.00 1 100.0%
Ambulatory surgical center 1 0.1% $750.00 1 100.0%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 768 83.0% $1586.12 449 58.5%
59 - Distinct Procedural Service 48 5.2% $775.63 45 93.8%
58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period 35 3.8% $2667.43 7 20.0%
GY 30 3.2% $906.23 30 100.0%
AQ 20 2.2% $2003.50 6 30.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.



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05/06/2016 03:33:23 54.87.24.251

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