CPT Code 92140

CPT code 92140 is a medical billing code for glaucoma provocative tests.

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What is CPT Code 92140

CPT code 92140 is designated for glaucoma provocative tests. These tests are diagnostic procedures used to assess the risk or presence of glaucoma by temporarily increasing intraocular pressure and then monitoring the eye's response. This helps in determining how well the fluid drains from the eye, which is crucial in diagnosing and managing glaucoma.

Does CPT 92140 Need a Modifier?

For CPT code 92140 (Glaucoma provocative tests), several modifiers may be applicable depending on the specific circumstances of the test administration and billing context. Here’s 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 test is being billed because the service was performed using equipment owned by another entity. The facility would bill separately for the technical component.

2. -TC Technical Component: Conversely, this modifier is used when only the technical component of the test is being billed. This is applicable when the equipment used is owned by the facility and the professional service is billed separately.

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

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

5. -50 Bilateral Procedure: If the glaucoma provocative tests were 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 test is distinct or independent from other services performed on the same day. This could be relevant if multiple tests or procedures are performed during the same patient visit.

7. -76 Repeat Procedure by Same Physician: Use this modifier if the test needs to be repeated on the same day by the same physician, possibly due to initial test error or other procedural issues.

8. -77 Repeat Procedure by Another Physician: This modifier is used if the test is repeated by a different physician on the same day, which might occur in a multi-specialist practice.

Each of these modifiers serves to clarify the specific circumstances under which the glaucoma provocative tests were administered, ensuring accurate billing and reimbursement. It’s essential to use the correct modifier(s) to avoid payment delays or denials due to billing errors.

CPT Code 92140 Medicare Reimbursement

The CPT code 92140, which refers to glaucoma provocative tests, is not typically reimbursed by Medicare. These tests are generally considered screening procedures, and Medicare does not cover routine screening for glaucoma except under specific conditions for high-risk patients. This includes individuals with diabetes, those with a family history of glaucoma, African Americans aged 50 and older, and Hispanic Americans aged 65 and older. Even in these cases, the coverage is for more standard diagnostic tests and examinations, not specifically for provocative tests like those coded under 92140.

For healthcare providers, it's important to note that billing for non-covered services could lead to denials unless patients are properly informed and agree to pay out-of-pocket. Always ensure that patients are aware of the coverage limitations and have signed an Advance Beneficiary Notice (ABN) if they choose to proceed with services that are likely to be denied by Medicare. This helps in maintaining compliance and transparency in healthcare billing practices.

Are You Being Underpaid for 92140 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize your contracts and identify discrepancies down to specific CPT codes, such as 92140 for glaucoma provocative tests, RevFind ensures that each claim is fully compensated according to the terms agreed with individual payers. Schedule a demo today to see how RevFind can safeguard your earnings by ensuring every procedure, including specialized tests like CPT 92140, is accurately reimbursed.

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