CPT Code 92135

CPT code 92135 is for diagnostic imaging of the eye's posterior segment.

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What is CPT Code 92135

CPT code 92135 is designated for ophthalmic diagnostic imaging of the posterior segment of the eye. This includes procedures such as scanning laser or optical coherence tomography (OCT) to assess conditions affecting the retina, choroid, and optic nerve. This code is typically used by healthcare providers to bill for the diagnostic imaging necessary to evaluate various eye diseases and conditions.

Does CPT 92135 Need a Modifier?

For CPT code 92135, which is related to ophthalmic diagnostic imaging, there are several modifiers that might be applicable depending on the specific circumstances of the billing situation. 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 service (interpretation of results, for example) is being billed because the equipment used for the imaging is owned by another entity. This is common in situations where the physician interprets results from imaging performed elsewhere.

2. -TC (Technical Component): Conversely, this modifier is used when only the technical component of the service is being billed. This applies when the imaging is performed using the provider’s equipment but the interpretation is done by another physician.

3. -LT (Left Side) and -RT (Right Side): These modifiers are used to specify which eye was imaged. This is crucial for accurate billing and medical records, as treatments and diagnostics might be specific to one eye.

4. -50 (Bilateral Procedure): If imaging is performed on both eyes during the same session, this modifier should be used to indicate a bilateral procedure, which can affect reimbursement rates.

5. -76 (Repeat Procedure by Same Physician): This modifier is used if the same procedure is repeated on the same day by the same physician. It may be necessary if initial imaging was unclear and needed to be redone.

6. -77 (Repeat Procedure by Another Physician): Similar to -76, but used if the repeat imaging is performed by a different physician on the same day.

7. -59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This might be applicable if different types of imaging or tests are performed during the same session.

8. -22 (Increased Procedural Services): If the service provided is more complex or requires more effort than usually required for this code, this modifier might be used to indicate the increased level of service.

Each of these modifiers serves to provide specific, necessary details that affect how the service is billed and reimbursed, ensuring that the provider receives accurate compensation for the services rendered, and that the billing aligns with payer requirements.

CPT Code 92135 Medicare Reimbursement

CPT code 92135, which pertains to ophthalmic diagnostic imaging of the posterior segment of the eye, has been replaced and is no longer in active use. The current codes that have replaced 92135 are 92133 and 92134. These codes are used for scanning computerized ophthalmic diagnostic imaging, with 92133 specifically for the optic nerve and 92134 for the retina.

Both CPT codes 92133 and 92134 are reimbursed by Medicare. The reimbursement rates for these codes can vary based on geographic location and the setting in which the service is provided (e.g., office vs. facility). To find the specific reimbursement amount for these codes in your area, you would need to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through your local Medicare administrator. This schedule provides detailed information on the reimbursement rates for all CPT codes covered by Medicare.

Are You Being Underpaid for 92135 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 92135 for ophthalmic diagnostic imaging, 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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