CPT Code 66170

CPT code 66170 is a medical billing code for trabeculectomy, a surgical procedure to treat glaucoma.

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What is CPT Code 66170

CPT code 66170 is designated for trabeculectomy, a surgical procedure performed to treat glaucoma by creating an opening in the eye to relieve intraocular pressure. This code specifically applies to the initial surgery without the use of an implant or device.

Does CPT 66170 Need a Modifier?

For CPT code 66170, which pertains to glaucoma surgery, specifically trabeculectomy or similar procedures, several modifiers may be applicable depending on the specific circumstances of the surgery and billing requirements. Here’s an ordered list of common modifiers that might be used with this code and the reasons for each:

1. -LT (Left side) and -RT (Right side): These modifiers are used to indicate which eye underwent the procedure. Since glaucoma surgery is often performed on one eye at a time, specifying the side is crucial for accurate billing and medical records.

2. -50 (Bilateral procedure): If the glaucoma surgery is performed on both eyes during the same surgical session, this modifier should be used. It often affects reimbursement rates, as some payers may not pay 100% for each side.

3. -51 (Multiple procedures): This modifier is used when multiple procedures are performed during the same surgical session. It helps in the adjustment of payment policies where the secondary or additional procedures may be reimbursed at a lower rate.

4. -59 (Distinct procedural service): This modifier indicates that a procedure or service was distinct or independent from other services performed on the same day. It is crucial for preventing the bundling of procedures and ensuring appropriate reimbursement.

5. -79 (Unrelated procedure or service by the same physician during the postoperative period): If a second, unrelated glaucoma surgery is performed during the postoperative period of the first, this modifier would be necessary to indicate that the procedures are not connected.

6. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): If an evaluation and management service is performed during the postoperative period that is unrelated to the original procedure, this modifier would be used.

7. -54 (Surgical care only): When only the surgical portion of the care is provided by the operating physician (and postoperative care is handled by another provider), this modifier is used.

8. -55 (Postoperative management only): This modifier is used when one physician performs the postoperative management but did not perform the surgical procedure.

9. -56 (Preoperative management only): Used when one physician performs the preoperative care but does not perform the surgery.

Each of these modifiers serves to provide clear, specific information that affects how billing is processed and how reimbursements are calculated, ensuring that the healthcare provider is accurately compensated for the services provided.

CPT Code 66170 Medicare Reimbursement

CPT code 66170, which pertains to glaucoma surgery specifically trabeculectomy or a filtering procedure, is generally reimbursed by Medicare. 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, you would need to consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through Medicare Administrative Contractors (MACs) that manage claims and payments in specific regions. These resources provide detailed information on the reimbursement rates applicable to different settings and localities.

It's important for healthcare providers to verify coverage and obtain any necessary pre-authorization from Medicare before performing the procedure to ensure that the services provided are within the scope of coverage and reimbursement guidelines. Additionally, staying updated with any changes in Medicare policies related to ophthalmology and specifically glaucoma surgery is crucial for compliance and optimal revenue cycle management.

Are You Being Underpaid for 66170 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to analyze contracts and identify discrepancies down to specific CPT codes, such as 66170 for glaucoma surgery, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can safeguard your earnings by ensuring accurate payments for every procedure code, including individual payer details.

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