CPT Code 92012

CPT code 92012 is a billing code for an established patient's eye examination.

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 92012

CPT code 92012 is used for billing purposes to denote an eye examination for an established patient. This code covers the evaluation and management of a patient who has previously been seen by the healthcare provider. The exam typically includes a general examination of the eye and adnexal structures, along with any necessary clinical decision-making based on the patient's history and current condition.

Does CPT 92012 Need a Modifier?

CPT code 92012 is used for an eye examination for an established patient, which includes a general medical examination and a detailed evaluation of the eye(s). When billing this code, certain modifiers may be necessary to accurately represent the service provided. Here is an ordered list of common modifiers that could be used with CPT code 92012 and the reasons for each:

1. -24: Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Use this modifier if the eye exam is performed during the postoperative period of a different procedure, and the exam is not related to the original procedure.

2. -25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Apply this modifier when, on the same day as the eye exam, an additional significant and separately identifiable E/M service is performed.

3. -57: Decision for Surgery
- Use this modifier if the eye exam leads to the decision to perform surgery on that day or the next day.

4. -LT and -RT: Left side and Right side
- These modifiers are used to specify which eye was examined if only one eye was involved in the detailed examination.

5. -50: Bilateral Procedure
- This modifier is used when the procedure involves both eyes.

6. -79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if a new eye exam is needed during the postoperative period of another unrelated procedure.

7. -AI: Principal Physician of Record
- This modifier indicates that the physician performing the eye exam is the principal physician of record.

Using these modifiers correctly ensures accurate billing and helps in avoiding claim denials. Each modifier has specific guidelines for use, so it's important to understand the circumstances of the patient encounter to apply them appropriately.

CPT Code 92012 Medicare Reimbursement

CPT code 92012, which refers to an eye examination for an established patient that includes a history, general medical observation, external and ophthalmoscopic examination, and may include biomicroscopy when performed, is typically reimbursed by Medicare. The reimbursement for this CPT code can vary based on geographic location and the setting in which the service is provided (e.g., office vs. facility).

To determine the specific reimbursement amount for CPT code 92012 under Medicare, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through your regional Medicare administrator. This schedule provides detailed information on the reimbursement rates applicable to different services in various regions.

It's important for healthcare providers to verify coverage and ensure that all documentation and coding are accurate to facilitate appropriate reimbursement for services rendered.

Are You Being Underpaid for 92012 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 pinpointing discrepancies down to the CPT code level, including specific codes like 92012 for established patient eye exams. This precision allows you to ensure that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every service rendered.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background