CPT Code 41800: What It Is, Modifiers, ReimbursementProductsRevFindUnderpayment detection, denial management, and contract optimization software that ingests your contract terms and identifies opportunities for net revenue uplift when payers stiff you.Use CasesResourcesCase StudiesResourcesContactCompanyCPT Code 41800CPT code 41800 is for the drainage of a gum lesion, detailing the specific procedure for billing and documentation in healthcare.Table of ContentsAccelerate your revenue cycleBoost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.What is CPT Code 41800CPT code 41800 is used to describe the procedure for draining a lesion located in the gum tissue. This code specifically pertains to the surgical intervention aimed at alleviating issues such as infection or abscess formation in the gums, allowing for the removal of pus or other fluids that may be causing discomfort or complications for the patient.Does CPT 41800 Need a Modifier?For the CPT code 41800 (Drainage of gum lesion), the following modifiers may be applicable:1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period.9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.CPT Code 41800 Medicare ReimbursementThe CPT code 41800 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services and procedures covered by Medicare, and it is essential to verify the current rates and any applicable modifiers that may affect reimbursement.Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement for CPT code 41800. MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and payment policies. Therefore, it is advisable to consult the relevant MAC for your region to ensure compliance with local coverage determinations and to obtain accurate reimbursement information for CPT code 41800.Are You Being Underpaid for 41800 CPT Code?Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 41800. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.Get paid in full by bringing clarity to your revenue cycleRelated CPT Codes001000010200103001040012000124001260014000142001440014500147001480016000162001640017000172001740017600190001920021000211002120021400215002160021800220002220030000320003220032600350003520040000402004040040600410004500045200454004700047200474005000052000522005240052800529005300053200534005370053900540005410054200546005480055000560005610056200563005660056700580006000060400620006220062500626006300063200634006350064000670007000070200730007310073200740007500075200754007560077000790007920079400796007971 / 7141800Subscribe to the Healthcare Clarified newsletterGet the latest insights on RCM and healthcare policy in your inboxPlease use a work email address.Thank you! Your submission has been received!Oops! Something went wrong while submitting the form.productsResourcesCompanyContact[email protected](800) 205-4675Follow us on LinkedInlegalproductsResourcesCompanyContact[email protected](800) 205-4675Follow us on LinkedInlegal© 2010-2024 MD Clarity. All rights reserved., The Current Procedural Terminology (CPT ®) code 41800 as maintained by American Medical Association, is a medical procedural code under the range - Incision Procedures on the Dentoalveolar Structures., CPT code 41800 is for the drainage of a gum lesion, detailing the specific procedure for billing and documentation in healthcare..