CPT Code 92136

CPT code 92136 is a medical billing code for ophthalmic biometry, measuring eye structures for surgery planning.

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What is CPT Code 92136

CPT code 92136 is designated for ophthalmic biometry, which involves measuring the eye, typically in preparation for cataract surgery. This procedure includes the use of techniques such as ultrasound, partial coherence interferometry, or other optical methods to accurately measure the eye's axial length and surface curvature. These measurements are crucial for determining the appropriate power and fit of intraocular lenses.

Does CPT 92136 Need a Modifier?

For CPT code 92136, which pertains to ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation, the use of modifiers can be essential depending on the specific billing circumstances and payer requirements. Here’s an ordered list of common modifiers that might be applicable to this code 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 or facility is owned by another entity. This is common in situations where the physician interprets results from tests performed at another location.

2. -TC Technical Component: Opposite to the -26 modifier, this is used when only the technical component (the actual performance of the biometry) is being billed. This might be used if the physician owns the equipment but does not interpret the results.

3. -LT Left Side and -RT Right Side: These modifiers are used to specify which eye was tested. Since biometry could be performed on one or both eyes, these modifiers help specify the exact service provided.

4. -50 Bilateral Procedure: If the biometry is performed on both eyes during the same session, this modifier would be appropriate to indicate a bilateral procedure.

5. -59 Distinct Procedural Service: This modifier is used to indicate that a service or procedure was distinct or independent from other services performed on the same day. This might be relevant if multiple procedures are performed on the same eye in one visit.

6. -76 Repeat Procedure by Same Physician: This modifier could be used if the biometry needs to be repeated in the same session by the same physician, perhaps due to initial measurement error.

7. -22 Increased Procedural Services: If the biometry procedure requires extra effort or time beyond the usual service scope, this modifier can be used to indicate that the service provided was more extensive than typically required.

Each of these modifiers serves to provide clear, specific information to payers to ensure appropriate reimbursement and to avoid billing errors. It’s important to check with specific payer policies as the applicability of modifiers can vary.

CPT Code 92136 Medicare Reimbursement

CPT code 92136, which pertains to ophthalmic biometry, is generally reimbursed by Medicare. This procedure involves measurements necessary for determining intraocular lens power before cataract surgery. The reimbursement for this code can vary based on geographic location and the setting in which the service is provided (e.g., outpatient hospital, physician's office).

To determine the specific reimbursement amount, it's advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through regional Medicare administrative contractors. These resources provide detailed information on the reimbursement rates applicable to different settings and geographic adjustments.

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