CPT Code 92242

CPT code 92242 is a medical billing code for combined fluorescein and indocyanine green angiography.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 92242

CPT code 92242 is used to bill for a diagnostic procedure known as fluorescein and indocyanine green (ICG) angiography. This code covers the combined use of both fluorescein and ICG dyes during angiography to provide detailed imaging of the blood vessels in the retina and choroid. This procedure is crucial for diagnosing and managing conditions affecting the eye's vascular system.

Does CPT 92242 Need a Modifier?

For CPT code 92242, which is used for fluorescein and indocyanine green angiography, several modifiers may be applicable depending on the specific circumstances of the billing situation. Here’s an ordered list of common modifiers that might be used with this code and the reasons for each:

1. -26 (Professional Component): This modifier is used when only the professional component of the procedure is being billed, meaning the service was provided by the physician but the equipment and supplies were provided by another entity.

2. -TC (Technical Component): Conversely, this modifier is used when only the technical component of the procedure is being billed. This applies when the equipment and technical staff are provided by the facility, but the physician is billing separately for their professional services.

3. -LT (Left Side) and -RT (Right Side): These modifiers are used to specify which eye the procedure was performed on. Fluorescein angiography can be performed on one or both eyes, so specifying the side is crucial for accurate billing.

4. -50 (Bilateral Procedure): This modifier is used if the procedure is performed on both eyes during the same session. It helps in ensuring that the billing reflects the bilateral nature of the procedure, which can affect reimbursement.

5. -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 necessary if fluorescein angiography is performed in conjunction with another eye procedure.

6. -76 (Repeat Procedure by Same Physician): This modifier is used if the procedure needs to be repeated on the same day by the same physician. It could be applicable in cases where initial imaging was unclear and needed to be redone.

7. -77 (Repeat Procedure by Another Physician): Similar to -76, but used when the repeat procedure is performed by a different physician.

8. -22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. This might be due to patient-specific factors that complicate the angiography.

Each of these modifiers serves to provide more specific information about how and under what circumstances the procedure was performed, which is crucial for appropriate reimbursement from insurance providers. Always ensure that the use of any modifier is supported by the documentation in the patient’s medical record.

CPT Code 92242 Medicare Reimbursement

CPT code 92242, which refers to fluorescein and indocyanine green angiography, is generally reimbursed by Medicare. This procedure is used for diagnostic imaging to evaluate retinal conditions. Reimbursement for this code 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).

As of the latest data, the Medicare reimbursement for CPT code 92242 can range approximately from $100 to $200. However, it's important to consult the Medicare Physician Fee Schedule (MPFS) specific to your locality for precise reimbursement rates, as these figures are subject to change and adjustments based on annual updates and regional fee schedule determinations.

Healthcare providers should also ensure that the documentation supports the medical necessity of the procedure to facilitate appropriate reimbursement and avoid denials. Additionally, checking with local Medicare Administrative Contractors (MACs) can provide further guidance specific to regional policies and any additional documentation requirements.

Are You Being Underpaid for 92242 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments. With the capability to drill down to specific CPT codes, such as 92242 for Fluorescein icg angiography, RevFind ensures that each claim is reimbursed correctly according to the terms of your agreements with individual payers. Schedule a demo today to see how RevFind can help secure the payments you are entitled to.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background