CPT Code 92145

CPT code 92145 is used for billing corneal hysteresis determination, a diagnostic eye test measuring corneal response.

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What is CPT Code 92145

CPT code 92145 is designated for the procedure known as corneal hysteresis determination. This test measures the biomechanical properties of the cornea, specifically its ability to absorb and dissipate energy, which is important in the assessment and management of conditions such as glaucoma. The procedure typically involves the use of specialized equipment to apply a brief pulse of air to the cornea and measure its response. This code is used for billing and documentation purposes in healthcare settings.

Does CPT 92145 Need a Modifier?

For CPT code 92145, which pertains to corneal hysteresis determination, the use 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 applicable to this CPT code 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 equipment or facility is not owned by the provider performing the interpretation.

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 provider 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 if only one eye was examined.

4. -50 Bilateral Procedure: This modifier is used if the procedure was performed on both eyes during the same session.

5. -59 Distinct Procedural Service: This modifier is used to indicate that the service is distinct or independent from other services performed on the same day.

6. -76 Repeat Procedure by Same Physician: This modifier may be used if the test needs to be repeated on the same day by the same physician.

7. -77 Repeat Procedure by Another Physician: This modifier is used if the test is repeated on the same day but by a different physician.

8. -91 Repeat Clinical Diagnostic Laboratory Test: In the rare case that this test is considered a clinical diagnostic laboratory test, this modifier could be used when the same test is repeated on the same day to obtain subsequent data.

Each of these modifiers serves to provide specific details that affect how billing is processed and how reimbursements are handled, ensuring that the claims are accurate and compliant with payer rules. Always verify with specific payer guidelines as modifier applicability can vary.

CPT Code 92145 Medicare Reimbursement

As of the latest updates, CPT code 92145, which refers to corneal hysteresis determination, is not typically reimbursed by Medicare. This specific test, used to measure the biomechanical properties of the cornea, is often considered not medically necessary under Medicare guidelines. Therefore, it is generally not covered, and healthcare providers may need to seek reimbursement through other insurance plans or patient self-pay options.

For healthcare providers, it's crucial to verify coverage with local Medicare contractors and other insurers to understand the specific reimbursement policies that may apply to this CPT code. Additionally, staying updated with any changes in Medicare coverage policies is essential for accurate billing and reimbursement practices.

Are You Being Underpaid for 92145 CPT Code?

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