CPT Code 67250

CPT code 67250 is a medical billing code for procedures that reinforce the eye wall.

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What is CPT Code 67250

CPT code 67250 is used to denote a surgical procedure involving the reinforcement of the eye wall. This procedure is typically performed to strengthen areas of the eye that may be weakened, often due to conditions like retinal detachment or other ocular structural concerns. The reinforcement might involve the use of materials such as scleral patches or other supportive substances to stabilize the eye and prevent further deterioration or complications.

Does CPT 67250 Need a Modifier?

For CPT code 67250, which pertains to reinforcing the eye wall, 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 (Left side): Used to indicate that the procedure was performed on the left eye.
2. -RT (Right side): Used to indicate that the procedure was performed on the right eye.
3. -50 (Bilateral procedure): Applied when the procedure is performed on both eyes during the same operative session.
4. -51 (Multiple procedures): Used when multiple procedures are performed during the same surgical session. This modifier helps in adjusting the reimbursement for the additional procedures.
5. -59 (Distinct procedural service): Indicates that the procedure was distinct or independent from other services performed on the same day.
6. -78 (Unplanned return to the operating/procedure room): Used if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. -79 (Unrelated procedure or service by the same physician during the postoperative period): This modifier is used if a new procedure (which is unrelated to the original procedure) is performed while the patient is still in the postoperative period.
8. -22 (Increased procedural services): Indicates that the work performed was substantially greater than typically required for the listed procedure.

Each modifier provides specific information that can affect billing and reimbursement, ensuring that the procedure is accurately documented and appropriately compensated.

CPT Code 67250 Medicare Reimbursement

CPT code 67250, which pertains to the reinforcement of the eye wall, is typically reimbursable by Medicare. However, the exact reimbursement amount can vary based on the geographic location and the setting in which the procedure is performed (e.g., outpatient hospital, ambulatory surgical center, or physician's office). It's important for healthcare providers to check the Medicare Physician Fee Schedule (MPFS) or contact their local Medicare Administrative Contractor (MAC) for specific reimbursement rates applicable to their region and practice setting. Additionally, providers should ensure that the procedure is medically necessary and properly documented to facilitate appropriate reimbursement.

Are You Being Underpaid for 67250 CPT Code?

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