CPT Code 92120

CPT code 92120 is a medical billing code for tonography and eye evaluation procedures.

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What is CPT Code 92120

CPT code 92120 is designated for tonography with eye evaluation, including water provocation when performed. This procedure involves measuring the facility of outflow of aqueous humor from the eye, which can be crucial in diagnosing and managing conditions like glaucoma. The test typically assesses the rate at which fluid drains through the eye's trabecular meshwork, providing valuable diagnostic information about the intraocular pressure and overall eye health.

Does CPT 92120 Need a Modifier?

For CPT code 92120, which pertains to tonography with interpretation and report, including water provocation when performed, certain modifiers may be applicable depending on the specific circumstances of the procedure and billing requirements. Here is an ordered list of potential modifiers and the reasons for their use:

1. -26 Professional Component: This modifier is used when only the professional component (interpretation and report) of the procedure is being billed because the technical component is being performed or billed by another entity.

2. -TC Technical Component: Use this modifier when only the technical component of the procedure is being billed, and the professional component is either performed by another provider or not billed.

3. -LT Left Side: This modifier indicates that the procedure was performed on the left eye.

4. -RT Right Side: This modifier indicates that the procedure was performed on the right eye.

5. -50 Bilateral Procedure: If the procedure is performed on both eyes during the same session, this modifier should be used to indicate a bilateral procedure.

6. -59 Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.

7. -76 Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day to address an issue or complete an incomplete test.

8. -77 Repeat Procedure by Another Physician: This modifier is similar to -76 but is used when the repeat procedure is performed by a different physician.

9. -91 Repeat Clinical Diagnostic Laboratory Test: In the rare case that tonography needs to be repeated as a diagnostic test on the same day, this modifier could be applicable.

Each of these modifiers serves to provide specific details that can affect billing and reimbursement processes, ensuring that the claims are accurately processed according to the services provided.

CPT Code 92120 Medicare Reimbursement

CPT code 92120, which pertains to tonography with eye evaluation, is generally reimbursable by Medicare. However, the specific coverage and reimbursement rates can vary based on the Medicare Administrative Contractor (MAC) that governs the region in which the service is provided. It is important for healthcare providers to verify coverage specifics with their local MAC.

As for the reimbursement amount, it can fluctuate based on the geographic location and the fee schedule set by Medicare for that year. Providers can find the most accurate and up-to-date reimbursement rates by consulting the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through their MAC's portal.

It's also crucial to ensure that the documentation supports the medical necessity of the procedure in order for the service to be reimbursed. Proper coding and documentation are key in avoiding denials and ensuring timely payment from Medicare.

Are You Being Underpaid for 92120 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. RevFind specializes in detecting discrepancies down to specific CPT codes, such as 92120 for tonography and eye evaluation, ensuring that each service rendered is reimbursed correctly according to your agreements with individual payers. Schedule a demo today to see how RevFind can help secure the payments you are entitled to, optimizing your financial outcomes efficiently.

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