CPT Code 92070

CPT code 92070 is for the fitting of a contact lens for treatment of eye disease, typically requiring specialized expertise.

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What is CPT Code 92070

CPT code 92070 is designated for the fitting of a contact lens for the management of a specific ocular surface condition. This involves selecting and fitting a contact lens to help treat or manage a condition affecting the cornea or conjunctiva, such as keratoconus or dry eye syndrome. The process may include multiple visits to ensure the correct fit and adequate response to the treatment.

Does CPT 92070 Need a Modifier?

For CPT code 92070, which pertains to the fitting of a contact lens for treatment of ocular surface disease, the use of modifiers can be essential depending on the specific billing circumstances and payer requirements. Here are some commonly applicable modifiers:

1. -RT (Right Side) and -LT (Left Side): These modifiers are used to specify which eye the contact lens fitting was performed on. Since treatments can differ between eyes, it's crucial to indicate the specific eye to ensure accurate billing and medical records.

2. -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): This modifier is used if, on the same day as the contact lens fitting, the patient also receives a significant, separately identifiable Evaluation and Management (E/M) service. This informs the payer that two distinct services were provided on the same day, which may affect reimbursement.

3. -22 (Increased Procedural Services): This modifier may be used if the service provided is more complex or requires more effort than typically required. Documentation should clearly support the increased level of service.

4. -59 (Distinct Procedural Service): Modifier -59 indicates that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to indicate that a procedure or service was separate and necessary at the same session but not normally reported together.

5. -76 (Repeat Procedure by Same Physician): This modifier is used if the procedure needs to be repeated on the same day by the same physician. It helps in distinguishing between a repeated service and an ongoing or adjusted service.

6. -TC (Technical Component): This modifier might be used if only the technical portion of the contact lens fitting is being billed, where applicable. It indicates that the claim is for the technical part only and not for the professional component.

7. -26 (Professional Component): Conversely to -TC, this modifier is used when only the professional component of the service is being billed. This is relevant if the practitioner is only responsible for the supervision and interpretation, not the technical execution.

Each modifier has specific guidelines for use, and it's important to consult with payer policies to ensure correct application and compliance with billing requirements.

CPT Code 92070 Medicare Reimbursement

CPT code 92070, which pertains to the fitting of a contact lens for treatment of ocular surface disease, is not typically reimbursed by Medicare. Medicare generally does not cover routine vision services, including the fitting of contact lenses, unless they are part of treatment for specific approved medical conditions. In the case of 92070, if the contact lens fitting is deemed medically necessary as part of treatment for an ocular surface disease, there might be an exception, but this is rare.

For healthcare providers, it's important to verify coverage directly with Medicare or through the patient's specific Medicare plan, as there can be variations based on individual circumstances and regional Medicare contractor policies. If reimbursement is provided, the amount would depend on the Medicare fee schedule applicable to the specific region and the provider's agreement with Medicare. Always ensure proper documentation and justification for the medical necessity in the patient's medical records to support the claim if you are proceeding with billing this code to Medicare.

Are You Being Underpaid for 92070 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 92070 for the fitting of contact lenses, RevFind ensures 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.

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