CPT Code 65855

CPT code 65855 is for billing trabeculoplasty laser surgery, a procedure to treat glaucoma.

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What is CPT Code 65855

CPT code 65855 is designated for trabeculoplasty by laser surgery. This procedure involves using a laser to treat the drainage angle of the eye, which can help reduce intraocular pressure in patients with glaucoma.

Does CPT 65855 Need a Modifier?

For CPT code 65855, which pertains to trabeculoplasty by laser surgery, several modifiers may be applicable depending on the specific circumstances of the procedure. Here’s an ordered list of potential modifiers and the reasons for their use:

1. -50 Bilateral Procedure: This modifier is used if the trabeculoplasty laser surgery is performed on both eyes during the same operative session. It indicates that the procedure was bilateral, which can affect reimbursement.

2. -LT Left Side: Indicates that the trabeculoplasty laser surgery was performed on the left eye. This is crucial for procedures where the side of the body on which the surgery was performed needs to be specified.

3. -RT Right Side: Used when the surgery is performed on the right eye. Similar to the -LT modifier, it specifies the side of the body involved in the procedure.

4. -22 Increased Procedural Services: This modifier may be used if the work required to perform the trabeculoplasty laser surgery was substantially greater than typically required. Documentation must support the significant additional work and the reason for it.

5. -52 Reduced Services: If the trabeculoplasty laser surgery was partially reduced or eliminated at the physician’s discretion, this modifier would be appropriate. It indicates that the procedure was curtailed without altering the basic service provided.

6. -53 Discontinued Procedure: Applied when the surgery is terminated after the induction of anesthesia or after the procedure has started due to extenuating circumstances or those that threaten the well-being of the patient.

7. -73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to Anesthesia Administration: Similar to -53 but specific to outpatient or ASC settings, used when the procedure is discontinued prior to the administration of anesthesia.

8. -74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Anesthesia Administration: Used in outpatient or ASC settings when the procedure is discontinued after anesthesia is administered.

Each of these modifiers provides specific information that can affect billing and reimbursement processes, ensuring that the claims accurately reflect the services provided. It’s essential for billing professionals to apply these modifiers correctly to comply with insurance requirements and to facilitate appropriate payment.

CPT Code 65855 Medicare Reimbursement

CPT code 65855, which pertains to trabeculoplasty by laser surgery, is generally reimbursed by Medicare. This procedure is commonly used in the treatment of glaucoma to reduce intraocular pressure by enhancing the drainage angle of the eye.

The reimbursement for CPT code 65855 can vary based on geographic location and the setting in which the procedure is performed (e.g., outpatient hospital, ambulatory surgical center, or physician's office). To determine the specific reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through Medicare Administrative Contractors (MACs) that manage specific regions.

It's important for healthcare providers to verify coverage and obtain any necessary pre-authorizations from Medicare before performing the procedure, as policies and reimbursement rates can change. Additionally, documentation and coding must be accurately completed to ensure proper reimbursement.

Are You Being Underpaid for 65855 CPT Code?

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