CPT Code 65920

CPT code 65920 is for the surgical removal of an eye implant.

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What is CPT Code 65920

CPT code 65920 is designated for the surgical procedure involving the removal of an implanted device from the eye. This code is used by healthcare providers to bill for the specific service of extracting an eye implant, which may be necessary due to complications, changes in the patient's condition, or other medically justified reasons.

Does CPT 65920 Need a Modifier?

For the CPT code 65920, which pertains to the removal of an implant from the eye, 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. -LT (Left side): Indicates that the procedure was performed on the left eye.

2. -RT (Right side): Indicates that the procedure was performed on the right eye.

3. -50 (Bilateral procedure): Used if the procedure was performed on both eyes during the same operative session. It's important to check payer policies as some may require billing each side on separate lines using -LT and -RT.

4. -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 if the removal of the eye implant was unplanned and required a return to the operating room after the initial surgery.

5. -79 (Unrelated procedure or service by the same physician during the postoperative period): If the removal of the eye implant occurs during the postoperative period of another unrelated procedure and requires the use of the operating room.

6. -22 (Increased procedural services): Indicates that the work performed was substantially greater than typically required for the procedure. This might be applicable if there were complications or unusual circumstances requiring additional effort and time.

7. -23 (Unusual anesthesia): Occasionally used if the procedure required general anesthesia where normally it would not.

8. -24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period): This could be applicable if the provider needs to perform an evaluation and management service during the postoperative period that is not related to the eye implant removal.

9. -59 (Distinct procedural service): Indicates that the procedure was distinct or independent from other services performed on the same day. This modifier is used to signify that the procedure is not normally reported together with other billed services but is appropriate under the circumstances.

10. -76 (Repeat procedure by same physician): Used if the procedure to remove the eye implant had to be repeated on the same day by the same physician.

Each modifier has specific guidelines for use, and it's crucial to verify with individual payer policies to ensure correct application and compliance with billing requirements.

CPT Code 65920 Medicare Reimbursement

CPT code 65920, which pertains to the removal of an implanted material from the eye, is generally covered and reimbursed by Medicare, assuming the procedure is medically necessary and the standard Medicare coverage criteria are met. The reimbursement for this procedure can vary based on geographic location, the setting in which the procedure is performed (hospital outpatient department vs. ambulatory surgical center), and other factors.

To determine the specific reimbursement amount for CPT code 65920, you would need to refer to the Medicare Physician Fee Schedule (MPFS) or the Outpatient Prospective Payment System (OPPS), depending on where the procedure is performed. These schedules are updated annually and can be accessed through the Centers for Medicare & Medicaid Services (CMS) website or through various Medicare administrative contractor (MAC) portals.

It's important for healthcare providers to verify coverage and obtain any necessary pre-authorization from Medicare prior to performing the procedure, as failure to do so could result in denial of reimbursement. Additionally, documentation should clearly support the medical necessity of removing the implant to facilitate smooth processing and payment of claims.

Are You Being Underpaid for 65920 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. RevFind is adept at reading your contracts and identifying discrepancies down to the specific CPT code level, such as CPT 65920 for the removal of an eye implant. This precision allows you to address underpayments for each individual payer effectively. Schedule a demo today to see how RevFind can help ensure your healthcare organization is fully compensated for the services you provide.

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