CPT Code 65114

CPT code 65114 is a medical procedure code for the removal or revision of an eye socket.

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What is CPT Code 65114

CPT code 65114 is designated for procedures involving the removal of an eye and the revision of the ocular socket. This code is used by healthcare providers to bill for surgical services related to enucleation or evisceration of the eye, which may include modifications to the eye socket to prepare for prosthetic placement or to address complications.

Does CPT 65114 Need a Modifier?

For CPT code 65114, which pertains to the removal of an eye or the revision of an orbital socket, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here is an ordered list of potential modifiers and the reasons for their use:

1. -22 (Increased Procedural Services): This modifier is used when the work required to perform the surgery is substantially greater than typically required. Documentation must support the significant additional work and the reason for it.

2. -51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier helps to indicate that this procedure is one of several others being billed at the same time.

3. -52 (Reduced Services): Applied when a service or procedure is partially reduced or eliminated at the physician's discretion. This could be relevant if the planned procedure was changed intraoperatively.

4. -53 (Discontinued Procedure): Used if the surgery is terminated after the patient is prepared due to extenuating circumstances or those that threaten the well-being of the patient.

5. -54 (Surgical Care Only): When one physician performs the surgical care and another provides preoperative and/or postoperative management.

6. -55 (Postoperative Management Only): Used when one physician performs the postoperative management and another physician performed the surgical procedure.

7. -56 (Preoperative Management Only): Indicates that a physician performed the preoperative care only, and another physician performed the surgery.

8. -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a procedure is performed during the postoperative period of an earlier surgery, is planned prospectively or is more extensive than the original procedure.

9. -59 (Distinct Procedural Service): Indicates that procedures that are normally bundled into one payment were performed in separate and distinct circumstances. This can help in situations where procedures that are typically bundled need to be billed separately due to unique clinical circumstances.

10. -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when a return to the operating room is required to address a complication from the initial procedure.

11. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when a new procedure (which is not related to the original procedure) is performed by the same physician during the postoperative period.

12. -RT (Right Side) and -LT (Left Side): These modifiers are used to specify which eye the procedure is being performed on, which is crucial for accurate medical documentation and billing.

Each of these modifiers addresses specific circumstances that might affect how the procedure is billed and reimbursed, ensuring that the billing process aligns with the actual services provided.

CPT Code 65114 Medicare Reimbursement

CPT code 65114, which pertains to the removal of an eye or the revision of an orbital socket, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location of the service, the setting in which the procedure is performed (e.g., hospital outpatient department vs. an ambulatory surgical center), and the Medicare Administrative Contractor (MAC) policies for the region.

To determine the exact reimbursement amount for CPT code 65114 under Medicare, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information on the reimbursement rates applicable to different procedural codes based on the locality.

Additionally, providers should ensure that the documentation supports the medical necessity of the procedure, as this is a critical factor in securing reimbursement. Pre-authorization may also be required depending on the patient’s specific Medicare plan and any applicable Medicare Advantage plan rules.

Are You Being Underpaid for 65114 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. RevFind's capability extends to detailed analysis at the CPT code level, including specific procedures like CPT 65114 for eye removal or socket revision. This ensures that each claim with individual payers is scrutinized for accurate reimbursement. Schedule a demo today to see how RevFind can help secure the payments you are entitled to, ensuring no detail, no matter how small, is overlooked.

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