CPT Code 92019

CPT code 92019 is a medical code for eye exams and treatments, used for billing purposes.

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 92019

CPT code 92019 is designated for an intermediate examination and treatment of the eye. This code is used specifically when the service provided includes an expanded evaluation of the eye(s) with the initiation or continuation of a diagnostic and treatment program. This code is applicable to both new and established patients.

Does CPT 92019 Need a Modifier?

CPT code 92019 is used for eye exams and treatment, typically involving intermediate services for the evaluation and management of an eye condition. When billing for services under this code, certain modifiers may be necessary to accurately describe the circumstances of the treatment provided. Here is an ordered list of common modifiers that could be applied to CPT code 92019 and the reasons for each:

1. -LT (Left side): Indicates that the service or procedure was performed on the left eye.
2. -RT (Right side): Indicates that the service or procedure was performed on the right eye.
3. -50 (Bilateral procedure): Used when the procedure is performed on both eyes during the same session.
4. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): This modifier is used if the eye exam is performed during a postoperative period but is unrelated to the original surgery.
5. -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service): Applied when, on the day a procedure identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the usual preoperative and postoperative care associated with the procedure.
6. -79 (Unrelated procedure or service by the same physician during the postoperative period): Used if a new procedure (which is unrelated to the initial procedure) is performed during the postoperative period of the initial procedure.

Each modifier provides specific information that helps in the accurate processing and reimbursement of claims, ensuring that the services rendered are clearly communicated to the payer.

CPT Code 92019 Medicare Reimbursement

CPT code 92019, which pertains to eye exams and treatment, is generally reimbursable by Medicare. However, the specific coverage and reimbursement amount can depend on several factors, including the medical necessity of the procedure, the setting in which the service is provided, and the patient's specific Medicare plan details.

For accurate reimbursement amounts, it's essential to consult the Medicare Physician Fee Schedule (MPFS) or contact Medicare directly. The MPFS provides detailed information on the reimbursement rates for each CPT code based on the geographic location and the setting of the service (e.g., office vs. facility). Additionally, ensure that documentation and coding practices align with Medicare's guidelines to facilitate appropriate reimbursement.

Are You Being Underpaid for 92019 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments with precision. For instance, if you're billing under CPT code 92019 for eye exams and treatments, RevFind meticulously analyzes agreements and payment data by individual payer to ensure you're receiving the correct reimbursements. Don't let discrepancies in payments go unnoticed. Schedule a demo today to see how RevFind can safeguard your earnings and streamline your billing processes.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background