| Code | Description |
|---|---|
| 92132 | SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, ANTERIOR SEGMENT, WITH INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL |
| 92133 | SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, WITH INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL; OPTIC NERVE |
What does CPT code 92133 mean?
What does CPT code 92133 mean? 92133: Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve. Is CPT 92134 covered by Medicare? 92133 and 92134 are subject to Medicare’s Multiple Procedure Payment Reduction (MPPR).
What is Procedure Code 92133?
CPT code 92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve.
Is 92133 a bilateral code?
Since Medicare defines the test as bilateral, these amounts apply whether one or both eyes are tested, and are adjusted in each area by local indices. Other payers set their own rates, which may differ significantly from the Medicare fee schedule. 92133 and 92134 are subject to Medicare’s Multiple Procedure Payment Reduction (MPPR). This reduces the allowable for the technical component of the lesser-valued test when more than one test is performed on the same day.
Does Medicare cover code 92133?
Claims for SCODI services (CPT codes 92133 and 92134) are payable under Medicare Part B in the following places of service: The global service is payable in the office (11), nursing facility (32- for Medicare patient not in a Part A stay) and independent clinic (49).
Is 92133 covered by Medicare?
92133 and 92134 are subject to Medicare's Multiple Procedure Payment Reduction (MPPR). This reduces the allowable for the technical component of the lesser-valued test when more than one test is performed on the same day.
Does Medicare cover optical coherence tomography?
Q: Does Medicare cover SCODI of the posterior segment with Topcon's 3D OCT-1 Maestro2? A: Yes. Scanning computerized ophthalmic diagnostic imaging of the posterior segment (SCODI-P) is covered by Medicare subject to the limitations in its payment policies; other third party payers generally agree.
Is CPT 92133 bilateral?
Coding Information CPT codes 92133 and 92134 are classified as unilateral or bilateral procedures.
How many times can you bill 92133?
Check your payer policies; they vary. Q: How often may SCODI-P be repeated? A: 92133 is generally allowed once per year for glaucomatous patients, and then usually for early or moderate disease.
What is the difference between 92133 and 92134?
92133: scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve. 92134: scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina.
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).
Can 92133 and 92083 be billed together?
you may not meet criteria to do 92083 AND 92133 on same DOS. You need to check your carrier's LCD for dxs, frequency, when both tests would be covered, etc.
What is the CPT code for optical coherence tomography?
92134As optical coherence tomography angiography (OCTA) grows in prevalence in the retina community, coding questions arise. OCTA should be reported with CPT 92134 alone. No other CPT code suffices, and no additional CPT code is needed. As for some other questions, read on.
Does Medicare accept eyelid modifiers?
For surgical procedures, Medicare states that modifier 50 should be used rather than the RT and LT modifiers because of the Medically Unlikely Edits. However, there are instances when the eyelid modifiers (E1, E2, E3, and E4) can be used. For diagnostic tests, either modifier 50 or the RT and LT modifiers may be used.
What is the CPT code for refraction?
CPT 92015Refraction: 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.
What is an OCT code?
On Jan. 1, a new Level I code replaced a Category III code for anterior segment OCT, which is also known as scanning computerized ophthalmic diagnostic imaging (SCODI). New code—92132 Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral.
What diagnosis goes with 92134?
As you can see, code 92134 in the CPT book is indented under 92133 and simply states “retina,” but it is read as follows: Scanning computer diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina.
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, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
Article Guidance
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35038, Scanning Computerized Ophthalmic Diagnostic Imaging.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted. The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 92132 – anterior segment:
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
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.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L34760 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI).
ICD-10-CM Codes that Support Medical Necessity
For the codes in the table that require a 7th character, the codes will be allowed for A initial encounter, D subsequent encounter and S sequel.
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.
Document 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
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Coverage Guidance
Abstract: Glaucoma is a leading cause of blindness, and a disease for which treatment methods clearly are available and in common use. Glaucoma also is diagnostically challenging. Almost 50% of glaucoma cases remain undetected.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Scanning Computerized Ophthalmic Imaging (L34380).
ICD-10-CM Codes that Support Medical Necessity
The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination. The following ICD-10-CM Diagnoses codes are used in conjunction with 92132 (anterior segment) only.
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.
Why does LCD not cover service?
This is because that item or service isn’t considered reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the function of a malformed part of the body.
What is part A of a LCD?
You can challenge an LCD if both of these apply: Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. , or both.
What is a local coverage determination?
What’s a "Local Coverage Determination" (LCD)? LCDs are decisions made by a Medicare Administrative Contractor (MAC) whether to cover a particular item or service in a MAC’s jurisdiction (region) in accordance with section 1862 (a) (1) (A) of the Social Security Act. MACs are Medicare contractors that develop LCDs and process Medicare claims.
What is Medicare Part B?
Medicare Part B (Medical Insurance) Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. , or both. You need the item (s) or service (s) determined not covered by the LCD.
What is MAC in Medicare?
MACs are Medicare contractors that develop LCDs and process Medicare claims. The MAC’s decision is based on whether the service or item is considered reasonable and necessary.
