CPT Code 92229

CPT code 92229 is used for billing retinal imaging with interpretation and monitoring, specifically for point-of-care analysis.

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What is CPT Code 92229

CPT code 92229 is used for billing purposes related to imaging retinal autofluorescence by detecting and monitoring diseases point-of-care analysis. This code specifically applies to the use of technology that captures and analyzes images of the retina to assess changes over time, aiding in the diagnosis and management of retinal conditions.

Does CPT 92229 Need a Modifier?

For CPT code 92229 (Imaging retinal autofluorescence, unilateral or bilateral, with interpretation and report), the application of modifiers can depend on various factors such as the specifics of the billing situation or payer requirements. Here are some commonly applicable modifiers for this CPT code:

1. -26 (Professional Component): This modifier is used when only the professional component of the service (interpretation and report) is provided. It is applicable if a different provider or entity performs the technical component.

2. -TC (Technical Component): Use this modifier when only the technical component of the service is provided, and another provider is responsible for the interpretation.

3. -50 (Bilateral Procedure): Although CPT 92229 is defined as unilateral or bilateral, this modifier might be used to specify that the procedure was performed bilaterally, depending on payer-specific billing policies.

4. -RT (Right Side) and -LT (Left Side): These modifiers are used to indicate which eye was imaged if only one eye was examined, despite the code's bilateral nature. Some payers may require these to clarify unilateral service.

5. -76 (Repeat Procedure by Same Physician): This modifier could be used if the procedure is repeated on the same day by the same physician, possibly due to initial inadequate results or other procedural issues.

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

7. -59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.

Each modifier has specific guidelines for use, and it's crucial to consult payer-specific policies and guidelines to ensure correct application and compliance.

CPT Code 92229 Medicare Reimbursement

CPT code 92229, which refers to imaging retinal autofluorescence by point-of-care automated analysis, is reimbursable by Medicare. As of the latest updates, the reimbursement rate for this code can vary based on the geographic location and the setting in which the service is provided (e.g., hospital outpatient department vs. a physician's office). It's advisable to check the Medicare Physician Fee Schedule (MPFS) for specific reimbursement amounts in your area, as these figures are subject to annual adjustments and regional differences.

Are You Being Underpaid for 92229 CPT Code?

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