Bill just the 92012 and the 92285 by themselves without a modifier. You only need the modifier for something like foreign body removal or some other procedure like that not for a test to be done, such as visual fields or OCT or photos. Tom Cheezum, O.D., CPC, COPC
Full Answer
What is the Medicare allowable amount for a 92285 physician?
The 2018 national Medicare Physician Fee Schedule allowable for 92285 is $21.24. Of this amount, $18.00 is assigned to the technical component and $3.24 is the value of the professional component ( i.e., interpretation). Medicare allowable amounts are adjusted in each area by local wage indices.
Can I Bill 92250 and 92133/92134 on the same DOS?
Most carriers will not reimburse for the 92250 and 92133/92134 being done on the same DOS because they are both considered imaging procedures which image the same part of the eye. Theoretically, according to the CCI edits, you can bill those two tests on the same DOS if you use a 59 modifier.
Do I need a modifier for a 92285 test?
You don't need the modifier for the test to be done the same day. Bill just the 92012 and the 92285 by themselves without a modifier. You only need the modifier for something like foreign body removal or some other procedure like that not for a test to be done, such as visual fields or OCT or photos.
Are CPT codes 92227 and 92228 retroactive?
Under CPT/HCPCS Codes Group 1: Codes descriptors were revised for 92227 and 92228. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.
Does Medicare cover 92285?
A Yes. According to Medicare's National Correct Coding Initiative (NCCI), 92285 is bundled with the surgical codes for blepharoplasty procedures (CPT 15820-15824). Both gonioscopy (92020) and the technician exam (CPT 99211), are bundled with 92285.
Is CPT code 92285 bilateral?
CPT code 92285 (External ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, stereo-photography) describes this service. CPT code 92285 is defined as “bilateral” so reimbursement is for both eyes.
How to bill 92285?
A CPT code 92285: External ocular photography with interpretation and report for documentation of medical progress, describes this service. For tear film imaging, CPT instructs providers to use 0330T.
Does Medicare cover 0507T?
Medicare (Fee-for-Service): Some Medicare Administrative Contractors (MACS) have posted a payment rate for 0507T. Check with your local MAC to determine coverage requirements and payment. responsibility prior to performing the service.
Is corneal topography covered by Medicare?
Q: What is Medicare's position on corneal topography and refractive surgery? A: Refractive surgery for the purpose of reducing dependence on eyeglasses or contact lenses is not covered by Medicare, nor are the associated diagnostic tests, including corneal topography (NCD §80.7).
Does Medicare accept eyelid modifiers?
Medicare has developed separate modifiers to report services performed on the upper and lower eyelid of each eye. Some examples of procedures that would require these modifiers would be trichiasis epilation; repair of blepharoptosis; excision and repair of eyelid or reconstruction of eyelid; and removal of lesions.
Is CPT 92134 covered by Medicare?
A: CPT instructs that 92133 and 92134 may not be reported at the same patient encounter. Medicare's National Correct Coding Initiative (NCCI) treats fundus photography (92250) as mutually exclusive with SCODI-P. The E/M service 99211 is bundled with this test.
Does Medicare pay for 92250?
A Yes. According to Medicare's National Correct Coding Initiative (NCCI), 92250 is bundled with ICG (92240) and mutually exclusive with scanning computerized ophthalmic diagnostic imaging of the posterior segment (92133 or 92134).
What is the CPT code for fundus photography?
92250What CPT code is used to report fundus photography? A. Use CPT code 92250 (Fundus photography with interpretation and report) to report this test.
What type of CPT codes are not accepted by Medicare?
Certain services are never considered for payment by Medicare. These include preventive examinations represented by CPT codes 99381-99397. Medicare only covers three immunizations (influenza, pneumonia, and hepatitis B) as prophylactic physician services.
Can you bill an OCT and visual field on the same day?
How does this work if there are three tests on the same day? The payment reduction is applied to both the CT and the OCT, since they are the lower-valued technical components. The visual field is allowed in full.
What is CPT 0507T?
A: The code descriptor for 0507T is as follows: “Near-infrared dual imaging (i.e., simultaneous reflective and trans-illuminated light) of meibomian glands, unilateral or bilateral, with interpretation and report.” CPT also has a parenthetical note for this code, which states “For external ocular photography, use 92285 ...
Is 92020 a bilateral code?
Code 92020 is defined by CMS as “bilateral,” so reimbursement is for both eyes. Unlike most other ophthalmic diagnostic tests, gonioscopy is not subdivided into a technical and professional component because no portion of the test can be delegated to a technician.
Is 92235 a bilateral code?
CPT Code 92242 can only be billed with a single diagnosis if that diagnosis is a covered diagnosis for both CPT Code 92235 and CPT Code 92240....Group 1.CodeDescription92235FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL2 more rows
How do you code an emergency room visit?
CPT 99284 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity.
How do you code an ED consult?
ED consultation: Patient is not admitted If the patient is a Medicare beneficiary, the general surgeon should bill the level of ED code (99281–99285). Non-Medicare patients are considered outpatients until they are admitted to the hospital, and therefore the outpatient consultation codes are reported (99241–99245).
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Article Guidance
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for the Ophthalmology: Extended Ophthalmoscopy and Fundus Photography L33467.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What is CPT 92015?
CPT 92015 describes refraction and any necessary prescription of lenses. Refraction is not separately reimbursed as part of a routine eye exam or as part of a medical examination and evaluation with treatment/diagnostic program.
How often is glaucoma screening covered by Medicare?
Glaucoma screening for high risk Medicare beneficiaries is covered once every 12 months and should be reported with HCPCSII code. Reporting screening, preventive or refractive error services with codes 92002-92014 is misrepresentation of the service, potentially to manipulate eligibility for benefits and is fraud.
What is the definition of 941.42?
941.42. Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face head and neck) without loss of body part. 941.52. Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face head and neck) with loss of a body part.