CPT Code 92240

CPT code 92240 is used for billing either unilateral or bilateral indocyanine green angiography.

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What is CPT Code 92240

CPT code 92240 is used to describe a diagnostic procedure known as indocyanine green (ICG) angiography. This code applies whether the angiography is performed on one eye (unilateral) or both eyes (bilateral). ICG angiography involves the use of a special dye, indocyanine green, which is injected into the bloodstream to help visualize blood flow in the retina and choroid layers of the eye through the use of imaging equipment. This procedure is typically used to diagnose and monitor certain eye conditions, such as macular degeneration or retinal vascular disorders.

Does CPT 92240 Need a Modifier?

For CPT code 92240, which pertains to indocyanine-green (ICG) angiography, either unilateral or bilateral, several modifiers may be applicable depending on the specific circumstances of the billing and the services provided. 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 service (interpretation of results, for example) is being billed because the equipment or facilities were provided by another entity.

2. -TC Technical Component: Use this modifier when only the technical component of the service (the actual performance of the ICG angiography) is being billed, and another professional is responsible for the interpretation.

3. -50 Bilateral Procedure: Although CPT 92240 can be billed for unilateral or bilateral procedures, this modifier is used to indicate that the procedure was performed bilaterally on the same day.

4. -RT Right Side: This modifier is used to specify that the procedure was performed on the right side of the body.

5. -LT Left Side: This modifier is used to specify that the procedure was performed on the left side of the body.

6. -59 Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This might be applicable if ICG angiography is performed in conjunction with another, separate procedure.

7. -76 Repeat Procedure by Same Physician: Use this modifier if the same physician had to repeat the ICG angiography procedure on the same day.

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

9. -91 Repeat Clinical Diagnostic Laboratory Test: In the rare case that ICG angiography is considered part of a diagnostic lab test and is repeated on the same day, this modifier would be applicable.

Each of these modifiers serves to provide specific details that can affect billing and reimbursement processes, ensuring that the services rendered are accurately documented and charged. It’s important for healthcare providers to use these modifiers correctly to comply with billing regulations and to facilitate appropriate payment from payers.

CPT Code 92240 Medicare Reimbursement

CPT code 92240, which refers to indocyanine green (ICG) angiography, either unilateral or bilateral, is generally reimbursed by Medicare. However, the specific amount of reimbursement can vary based on the geographic location and the setting in which the service is provided (e.g., outpatient hospital, physician's office). To determine the exact reimbursement rate, 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 claims and payments in specific regions.

Are You Being Underpaid for 92240 CPT Code?

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