CPT Code 92134

CPT code 92134 is for diagnostic imaging of the eye's posterior segment, including the retina and optic nerve.

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What is CPT Code 92134

CPT code 92134 is used to bill for diagnostic imaging of the posterior segment of the eye. This includes detailed scanning of structures such as the retina, choroid, and optic nerve. The procedure typically involves the use of advanced imaging technologies like optical coherence tomography (OCT) to capture detailed cross-sectional images that help in diagnosing and managing various ocular conditions. This code is specific to non-contact, non-invasive imaging and does not include interpretation and report, which are billed separately.

Does CPT 92134 Need a Modifier?

For CPT code 92134 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina), the application of modifiers can be essential depending on the specific billing circumstances and payer requirements. Here is an ordered list of common modifiers that might be used with this CPT code and the reasons for each:

1. -RT (Right side) and -LT (Left side):
- Reason: These modifiers are used to specify which eye was examined if the service was performed on only one eye. Although 92134 is typically billed as a bilateral service, specifying laterality can be necessary if only one eye is examined due to patient condition or payer requirements.

2. -50 (Bilateral procedure):
- Reason: This modifier is used to indicate that the procedure was performed on both eyes. However, for CPT 92134, this modifier is generally not needed as the code inherently implies a bilateral service unless otherwise specified by RT or LT modifiers.

3. -TC (Technical component):
- Reason: This modifier is used when only the technical component (i.e., the actual imaging service) is provided, and the interpretation and report are not performed by the billing provider.

4. -26 (Professional component):
- Reason: This modifier is used when only the professional component (i.e., interpretation and report of the imaging) is provided, separate from the technical component.

5. -76 (Repeat procedure by same physician):
- Reason: This modifier is used if the same provider performs a repeat of the imaging procedure on the same day, to indicate that this is a separate and distinct service from the first.

6. -59 (Distinct procedural service):
- Reason: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. This might be necessary if other, potentially overlapping diagnostic procedures are performed.

7. -GA (Waiver of liability statement on file):
- Reason: This modifier is used to indicate that an Advance Beneficiary Notice (ABN) is on file and that the provider may bill the patient for services if they are not covered by Medicare.

8. -GY (Item or service statutorily excluded):
- Reason: This modifier is used to indicate that the service is not covered by Medicare and, therefore, the patient is responsible for payment.

9. -GZ (Item or service expected to be denied as not reasonable and necessary):
- Reason: This modifier is used when no ABN is on file but the provider expects that Medicare will deny the payment as not reasonable and necessary.

Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. It's important to check with specific payer policies as the requirements for modifier use can vary.

CPT Code 92134 Medicare Reimbursement

CPT code 92134, which refers to "Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral," is reimbursed by Medicare. This code is commonly used in the management and diagnosis of various retinal conditions, and it is crucial for healthcare providers to understand its reimbursement status for proper billing and revenue cycle management.

The reimbursement for CPT code 92134 can vary based on geographic location and the Medicare Administrative Contractor (MAC) policies in place. However, as a general guideline, the Medicare Physician Fee Schedule (MPFS) provides a national average reimbursement rate. As of the latest data available, the national average Medicare reimbursement for CPT code 92134 is approximately $40 to $50 per session. It's important to note that this amount is subject to change due to annual updates in the MPFS and potential adjustments in Relative Value Units (RVUs) or conversion factors.

Healthcare providers should verify the specific reimbursement rates applicable to their locality and ensure that their billing practices align with the latest Medicare guidelines and fee schedules. Additionally, it's advisable to check for any recent updates or changes in policy that might affect the reimbursement for this CPT code.

Are You Being Underpaid for 92134 CPT Code?

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