CPT Code 92130

CPT code 92130 is a medical procedure code for water provocation tonography.

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What is CPT Code 92130

CPT code 92130 is designated for the procedure known as water provocation tonography. This test is used in ophthalmology to assess the eye's ability to drain fluid. It involves measuring the intraocular pressure (IOP) before and after the administration of water, which helps in evaluating the function of the drainage angle and the aqueous outflow facility of the eye. This test is particularly useful in diagnosing and managing conditions like glaucoma, where the fluid dynamics of the eye are critical.

Does CPT 92130 Need a Modifier?

For CPT code 92130, which is specific to water provocation tonography, several modifiers may be applicable depending on the specific circumstances of the procedure and billing context. 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 of the procedure is being billed, meaning the service provided by the physician, excluding any facility or equipment fees.

2. -TC Technical Component: Opposite to the -26 modifier, this is used when only the technical component of the procedure is being billed. This includes the use of equipment and technical staff but does not include the professional services provided by the physician.

3. -LT Left Side: Used when the procedure is performed on the left eye. This helps in specifying which eye was tested, which is crucial for accurate medical records and billing.

4. -RT Right Side: Similar to the -LT modifier, this is used when the procedure is performed on the right eye.

5. -50 Bilateral Procedure: This modifier is used when the procedure is performed on both eyes during the same session. It helps in billing processes where procedures are done bilaterally.

6. -59 Distinct Procedural Service: Used to indicate that the procedure was distinct or independent from other services performed on the same day. This modifier is crucial for preventing bundling and ensuring proper reimbursement.

7. -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, which might be necessary if initial tonography results were inconclusive or problematic.

8. -77 Repeat Procedure by Another Physician: Similar to -76, but used when a different physician repeats the procedure on the same day.

9. -22 Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This might be due to complications or specific patient conditions that make the procedure more complex.

10. -23 Unusual Anesthesia: Occasionally, if unusual anesthesia is required for the tonography (beyond typical topical anesthesia), this modifier would be appropriate.

Each of these modifiers serves to provide specific, necessary details that affect how the procedure is billed and reimbursed, ensuring clarity and compliance with billing regulations. It's important for healthcare providers to use these appropriately to reflect the actual services rendered.

CPT Code 92130 Medicare Reimbursement

CPT code 92130, which refers to water provocation tonography, is not a commonly used or recognized CPT code in the context of Medicare reimbursement. It does not appear in the Medicare Physician Fee Schedule, and there is no established Relative Value Unit (RVU) or payment amount associated with this code for Medicare.

Healthcare providers should verify the validity and applicability of this CPT code with Medicare or consult the latest updates from the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) for accurate and current billing practices. It's possible that this procedure may need to be coded differently or that specific documentation is required to justify its medical necessity if it is not directly reimbursable under a straightforward CPT code like 92130.

Are You Being Underpaid for 92130 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to read your contracts and identify discrepancies down to specific CPT codes, such as 92130 for water provocation tonography, RevFind ensures that each service rendered 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 procedure, including individual payer details. Take the first step towards optimized revenue with MD Clarity.

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