CPT Code 92018

CPT code 92018 is a billing code for a new patient's comprehensive eye exam and treatment.

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What is CPT Code 92018

CPT code 92018 is designated for a new patient comprehensive eye examination and treatment. This code is used by healthcare providers to bill for a thorough evaluation of the eye and adnexa, which includes a general medical observation and detailed inspection of the ocular and adnexal structures. It also encompasses initiation or continuation of diagnostic and treatment programs.

Does CPT 92018 Need a Modifier?

CPT code 92018 is used for a new patient comprehensive eye examination and treatment. When billing this code, various modifiers may be necessary to accurately describe the circumstances of the service provided. Here is an ordered list of potential modifiers that could be used with CPT code 92018 and the reasons for each:

1. -25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier if the physician performs a significant, separate evaluation and management service on the same day as the eye exam.

2. -57 - Decision for Surgery: Apply this modifier if the eye exam leads to the decision to perform surgery on that day or the next day.

3. -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.

4. -50 - Bilateral Procedure: Use this modifier if the procedure was performed on both eyes during the same session.

5. -22 - Increased Procedural Services: This modifier is used when the work required to perform the service is substantially greater than typically required.

6. -24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: If the eye exam is performed during the postoperative period of a different procedure and is not related to the original procedure, this modifier should be used.

7. -79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if a new or different procedure is performed by the same physician during the postoperative period of a different, unrelated surgery.

These modifiers help ensure that the billing for CPT code 92018 is precise and reflects the specific circumstances under which the service was provided. Proper use of these modifiers is crucial for appropriate reimbursement and to avoid claims denials.

CPT Code 92018 Medicare Reimbursement

CPT code 92018 is used for a new patient comprehensive eye examination and treatment. This code is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on the geographic location and the Medicare Administrative Contractor (MAC) policies in that region.

To determine the exact reimbursement amount for CPT code 92018, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information on reimbursement rates based on the specific locality.

Additionally, it's important for providers to ensure that the documentation supports the level of service billed and that the services meet all applicable Medicare coverage and medical necessity guidelines to avoid denials or audits.

Are You Being Underpaid for 92018 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 92018 for new eye exams and treatments, RevFind ensures that each service is reimbursed correctly according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every individual payer and service.

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