CPT Code 65140

CPT code 65140 is a medical billing code for the procedure of attaching an ocular implant.

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What is CPT Code 65140

CPT code 65140 is used to denote the medical procedure of attaching an ocular implant. This code is utilized when a healthcare provider surgically inserts an implant into the eye, which could be for various medical reasons including but not limited to improving visual function or replacing damaged ocular structures.

Does CPT 65140 Need a Modifier?

For the CPT code 65140, which pertains to the attachment of an ocular implant, several modifiers may be applicable depending on the specific circumstances of the surgery and billing context. Here is an ordered list of potential modifiers and the reasons for their use:

1. -LT (Left side) and -RT (Right side): These modifiers are used to specify which eye received the implant, important for clarifying the site of the procedure.

2. -50 (Bilateral procedure): If ocular implants are attached to both eyes during the same surgical session, this modifier would be appropriate to indicate a bilateral procedure.

3. -51 (Multiple procedures): Used if the attachment of the ocular implant is performed alongside other distinct procedures during the same surgical session. This modifier helps in adjusting the reimbursement for multiple procedures that are not usually performed together.

4. -59 (Distinct procedural service): This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is crucial for separating procedures that are commonly bundled but were necessary to perform separately under the specific circumstances.

5. -22 (Increased procedural services): If the procedure requires more effort than typically required, such as due to scar tissue or other complications, this modifier can be used to indicate an increased level of complexity and effort.

6. -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 applicable if a return to surgery is required to adjust or reposition the ocular implant within the global period of the original surgery.

7. -79 (Unrelated procedure or service by the same physician during the postoperative period): If another procedure, unrelated to the ocular implant, is performed during the postoperative period of the initial surgery, this modifier would be used.

8. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): If an evaluation and management service unrelated to the ocular implant procedure is performed during the postoperative period, this modifier should be applied.

Each of these modifiers serves to provide clear, specific information that affects billing and reimbursement processes, ensuring that the services rendered are accurately documented and compensated.

CPT Code 65140 Medicare Reimbursement

CPT code 65140, which pertains to the attachment of an ocular implant, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location of the service provider, the setting in which the procedure is performed (e.g., hospital outpatient department vs. ambulatory surgical center), and the Medicare Administrative Contractor (MAC) policies for the region.

To determine the exact reimbursement amount for CPT code 65140, healthcare providers should 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 reimbursement rates based on the provider's locality. Additionally, providers should verify coverage and payment details with their local MAC to ensure compliance with specific regional guidelines and policies that may affect reimbursement for this procedure.

Are You Being Underpaid for 65140 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize contracts and identify discrepancies down to specific CPT codes, such as 65140 for attaching an ocular implant, RevFind ensures that each service rendered is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every procedure, including individual payer details.

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