CPT Code 65091

CPT code 65091 is a medical billing code used to denote a specific type of eye surgery, primarily for revising the eye.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 65091

CPT code 65091 is designated for a surgical procedure specifically involving the revision of an eye. This code is used by healthcare providers for billing and documentation purposes when performing a corrective or adjustment surgery on the eye.

Does CPT 65091 Need a Modifier?

For CPT code 65091, which is used for an eye procedure, several modifiers may be applicable depending on the specific circumstances of the surgery and billing requirements. Here is an ordered list of potential modifiers and the reasons for their use:

1. -LT (Left Side): Used to indicate that the procedure was performed on the left eye.

2. -RT (Right Side): Used to indicate that the procedure was performed on the right eye.

3. -50 (Bilateral Procedure): Applied when the procedure is performed on both eyes during the same surgical session.

4. -51 (Multiple Procedures): Used when multiple procedures are performed during the same session. This modifier helps in adjusting the reimbursement for the additional procedures.

5. -59 (Distinct Procedural Service): Indicates that the procedure was distinct or independent from other services performed on the same day.

6. -78 (Unplanned Return to the Operating/Procedure Room): Used when a patient needs to return to the operating room for a related procedure during the postoperative period.

7. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a new procedure (unrelated to the original) is performed by the same physician during the postoperative period.

Each of these modifiers serves to provide specific details that affect how billing and reimbursement are handled for the procedure coded as 65091. It is crucial to select the appropriate modifier(s) based on the specific clinical and procedural circumstances to ensure accurate and efficient billing.

CPT Code 65091 Medicare Reimbursement

CPT code 65091, which pertains to a specific ophthalmological procedure, is generally reimbursable by Medicare. However, the exact reimbursement amount can vary based on the geographic location and the setting in which the service is provided (e.g., hospital outpatient department vs. an ambulatory surgical center). To determine the precise reimbursement rate, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through your Medicare Administrative Contractor (MAC). This will provide the most accurate and up-to-date information regarding reimbursement for CPT code 65091 under Medicare.

Are You Being Underpaid for 65091 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments with precision down to the CPT code level, including specific codes like 65091 for eye revision procedures. Schedule a demo today to see how RevFind can help you secure correct payments from each individual payer and ensure your financial operations are as efficient as possible. Don't let underpayments go unnoticed—let RevFind safeguard your revenue.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background