CPT Code 92071

CPT code 92071 is a medical code for fitting a contact lens as part of a treatment plan.

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What is CPT Code 92071

CPT code 92071 is designated for a contact lens fitting specifically for the treatment of ocular surface disease. This involves the healthcare provider selecting and fitting a contact lens to help manage and alleviate the symptoms associated with diseases affecting the surface of the eye, such as dry eye syndrome or keratitis. The process includes evaluating the fit of the lens on the eye, instructing the patient on proper lens care and usage, and possibly scheduling follow-up visits to ensure the treatment is effective.

Does CPT 92071 Need a Modifier?

For CPT code 92071, which is designated for contact lens fitting for treatment purposes, several modifiers may be applicable depending on the specific circumstances of the service provided. Here is an ordered list of potential modifiers and the reasons for their use:

1. -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 the provider performs a significant, separate evaluation and management service on the same day as the contact lens fitting.

2. -RT (Right Side) and -LT (Left Side) - These modifiers are used to specify which eye the contact lens fitting pertains to. This is crucial if the fitting is only for one eye.

3. -E1 to -E4 - Eyelid modifiers (Upper left, upper right, lower left, lower right): These can be used if the fitting or treatment is specific to eyelids affecting the fitting or use of the contact lens.

4. -GA - Waiver of Liability Statement Issued as Required by Payer Policy: This modifier is used when a waiver of liability statement has been issued because the service is expected to be denied as not reasonable and necessary under Medicare Part B.

5. -GY - Item or Service Statutorily Excluded or Does Not Meet the Definition of Any Medicare Benefit: This modifier is used to indicate that the service is not covered by Medicare and the provider expects denial.

6. -TC - Technical Component: This modifier could be used if only the technical portion of the contact lens fitting is being billed (if applicable).

7. -22 - Increased Procedural Services: This modifier is used when the work required to provide a contact lens fitting is substantially greater than typically required.

8. -59 - Distinct Procedural Service: This modifier is used to indicate that the service is distinct or independent from other services performed on the same day.

Each of these modifiers serves to provide additional information to the payer about the circumstances of the contact lens fitting, which can affect reimbursement. It is important for billing and coding professionals to apply these modifiers correctly to ensure accurate and timely payment for services rendered.

CPT Code 92071 Medicare Reimbursement

CPT code 92071, which is designated for a contact lens fitting for treatment purposes, is generally not covered by Medicare. Medicare typically does not reimburse for vision services, including contact lens fittings, unless they are part of treatment for specific diseases or conditions that affect the eye and are not primarily for the convenience of the patient. For instance, if the contact lens fitting is part of the post-operative care for cataract surgery or is used in the treatment of keratoconus, there might be coverage under certain circumstances.

However, for routine contact lens fittings, Medicare does not provide reimbursement. Providers should verify coverage specifics directly with Medicare or through the appropriate Medicare Administrative Contractor (MAC) for their region, as there can be regional variations and exceptions based on medical necessity and specific patient conditions.

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