Does Medicare cover CPT code 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).
Does 92250 need a modifier?
CPT codes 92250 and 92228 describe services that are performed bilaterally. Modifier 50 is never appropriate with these codes.
Does Medicare recognize modifier 52?
Modifier -52 (reduced services) must not be used with an evaluation and management service. Medicare does not recognize modifier -52 for this purpose. If modifier 52 is used on an E&M service code, the code will be rejected.
When should modifier 52 not be used?
Modifier -52 should not be used when the full service is performed but the total fee for the service is reduced or discounted. No CPT modifier exists for a reduced fee2.
What modifier is used with 92250?
MODIFIER 52 AS APPLIED TO DIAGNOSTIC TESTS CPT code 92250 does not contain the unilateral or bilateral descriptor, and payment is based on both sides being tested. Thus, if only one side is tested, this is considered a reduced service.
How do I bill my 92250?
Note: Use 92250 only to report photographs obtained with a camera on film or digital media. Note: Use 92499 to identify fundus images obtained with scanning laser equipment. It should be noted that there are National Correct Coding Initiative (NCCI) mutually exclusive edits for CPT codes 92135 and 92250.
How does modifier 52 affect reimbursement for Medicare?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
Does modifier 52 affect payment?
Reimbursement Guidelines There are no industry standards for reimbursement of claims billed with Modifier 52 from the Centers for Medicare and Medicaid Services (CMS) or other professional organizations.
What is the difference between modifier 52 and 53?
By definition, modifier 53 is used to indicate a discontinued procedure and modifier 52 indicates reduced services. In both the cases, a modifier should be appended to the CPT code that represents the basic service performed during a procedure.
What does a 52 modifier mean?
partial reduction, cancellationModifier 52 This modifier is used to indicate partial reduction, cancellation or discontinuation of services for which anesthesia is not planned. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
Can modifier 52 and 22 be used together?
Modifier 22 should not be billed with Modifier 52-Reduced Services.
Can modifier 51 and 52 be used together?
Moda Health will deny 98940 - 98943 for invalid modifier combination when billed with modifier 51. 52 Modifier 52 (reduced services) signifies that only part of the code description was performed, some parts were omitted.