CPT Code 92228

CPT code 92228 is used for billing retinal imaging with interpretation and monitoring by a physician or qualified healthcare professional.

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What is CPT Code 92228

CPT code 92228 is used for billing and coding remote imaging for detection or monitoring of diseases, specifically performed by a physician or other qualified healthcare professional. This code is typically associated with telemedicine services where images, such as those from retinal scans, are evaluated remotely to diagnose or monitor conditions.

Does CPT 92228 Need a Modifier?

For CPT code 92228 (Imaging of retina for detection or monitoring of disease, with physician or qualified health professional interpretation and report), the application of modifiers can be essential for correct billing and reimbursement. Here are some commonly used modifiers for this code and the reasons for their use:

1. -26 Professional Component: This modifier is used when only the professional component (interpretation and report) of the service is being billed because the technical component is being performed and billed by another entity.

2. -TC Technical Component: Conversely, this modifier is applied when only the technical component (the actual imaging service) is billed because the professional component is being handled by another provider.

3. -LT Left Side: Indicates that the service was performed on the left eye.

4. -RT Right Side: Indicates that the service was performed on the right eye.

5. -50 Bilateral Procedure: Used when the procedure is performed on both eyes during the same session.

6. -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.

7. -76 Repeat Procedure by Same Physician: Used if the procedure is repeated by the same physician on the same day to ensure proper reimbursement.

8. -77 Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day.

Each of these modifiers addresses specific billing circumstances that might arise due to the nature of the service provided, the involvement of multiple providers, or the need to specify which eye was treated. Proper use of these modifiers ensures accurate and efficient processing of claims for reimbursement.

CPT Code 92228 Medicare Reimbursement

CPT code 92228, which refers to imaging retinal autofluorescence by confocal laser ophthalmoscopy, is reimbursable by Medicare. This code is typically used for services related to the detection and monitoring of certain eye conditions, such as age-related macular degeneration or diabetic retinopathy.

The reimbursement for CPT code 92228 can vary based on geographic location and the setting in which the service is provided (e.g., hospital outpatient department vs. a physician's office). To determine the specific reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through Medicare Administrative Contractors (MACs) that manage these claims in specific regions.

It's important for healthcare providers to ensure that the documentation supports the medical necessity of using this CPT code, as this is a crucial aspect of securing reimbursement from Medicare. Additionally, staying updated with any changes in Medicare's coverage policies regarding this code is essential for accurate billing and reimbursement.

Are You Being Underpaid for 92228 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments with precision down to the CPT code level, including specific codes like 92228 for imaging retina detection/monitoring. Schedule a demo today to see how RevFind can help you secure correct payments from each payer, ensuring your financial operations are as efficient as possible.

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