CPT Code 65815

CPT code 65815 is a medical code for the procedure of draining fluid from 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 65815

CPT code 65815 is designated for procedures involving the drainage of the eye. This code is used when a healthcare provider performs a surgical procedure to drain fluid from the eye, which may be necessary to treat conditions such as glaucoma or other issues that cause increased intraocular pressure. This procedure helps to relieve pressure and prevent damage to the eye structures.

Does CPT 65815 Need a Modifier?

For CPT code 65815, which pertains to the drainage of the eye, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is an ordered list of potential modifiers and the reasons for their use:

1. -LT and -RT
- Reason: These modifiers indicate that the procedure was performed on the left side (-LT) or the right side (-RT) of the body. Since 65815 could be performed on one eye or the other, specifying the side is crucial for accurate billing and medical records.

2. -50
- Reason: This modifier is used when the procedure is performed bilaterally, meaning on both eyes in the same session. It is important to check payer policies as some may require the procedure to be billed on two separate lines with -LT and -RT instead of using -50.

3. -51
- Reason: Used when multiple procedures are performed during the same surgical session. This modifier helps to indicate that multiple procedures were done, which might affect reimbursement rates.

4. -59
- Reason: This distinct procedural service modifier is used to signify that a procedure or service was distinct or independent from other services performed on the same day. This could be applicable if another significant, separately identifiable service is performed on the same eye.

5. -24
- Reason: This modifier is used when an unrelated evaluation and management service is performed by the same physician during a postoperative period. If the physician needs to evaluate the patient for a different issue unrelated to the drainage procedure within the postoperative period, this modifier would be appropriate.

6. -78
- Reason: Used for an unplanned return to the operating room for a related procedure during the postoperative period. If complications arise requiring additional surgical intervention related to the original drainage, this modifier would be applicable.

7. -79
- Reason: Indicates an unrelated procedure or service by the same physician during the postoperative period. If a new issue arises and a separate procedure is needed, this modifier would be used.

Each of these modifiers serves to provide specific details that can affect billing and reimbursement. It is essential for healthcare providers to use these modifiers correctly to ensure compliance with payer requirements and to facilitate accurate payment for services rendered.

CPT Code 65815 Medicare Reimbursement

CPT code 65815, which pertains to the drainage of the eye, is typically reimbursable by Medicare. However, the exact reimbursement amount can vary based on several factors including the geographic location where the service is provided, the setting (such as inpatient or outpatient), and the specific Medicare administrative contractor (MAC) policies.

To determine the precise reimbursement amount for CPT code 65815, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through their regional MAC. This schedule provides detailed information on the reimbursement rates applicable to different procedures under Medicare.

It's also important to ensure that the documentation supports the medical necessity of the procedure, as this is a critical factor in securing reimbursement from Medicare. Proper coding and adherence to Medicare guidelines are essential to optimize revenue cycle management for services like the drainage of the eye.

Are You Being Underpaid for 65815 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize your contracts and identify discrepancies down to specific CPT codes, such as 65815 for drainage of eye procedures, RevFind ensures that each claim is fully compensated according to the terms agreed with individual payers. Schedule a demo today to see how RevFind can help secure the payments you are entitled to.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background