CPT Code 92250

CPT code 92250 is used for billing an eye exam that includes photography, aiding in diagnosing eye conditions.

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What is CPT Code 92250

CPT code 92250 is used to document a diagnostic procedure known as fundus photography. This involves capturing detailed images of the interior surface of the eye, including the retina, optic disc, macula, and posterior pole (the back part of the eye). The procedure is essential for diagnosing, monitoring, and managing various eye conditions and diseases.

Does CPT 92250 Need a Modifier?

CPT code 92250 refers to "Fundus photography with interpretation and report." This procedure involves the use of photography for ophthalmic imaging to document and monitor clinical findings in the eye's fundus. When billing for this service, certain modifiers may be applicable depending on the specific circumstances of the service provided. Here is an ordered list of potential modifiers that could be used with CPT code 92250 and the reasons for each:

1. -26 (Professional Component): This modifier is used when only the professional component of the service (interpretation and report) is provided by the physician, and the technical component (the photography itself) is provided by another entity.

2. -TC (Technical Component): Conversely, this modifier is applied when only the technical component is provided by the billing entity and the professional component is handled separately.

3. -LT (Left side) and -RT (Right side): These modifiers are used to specify services performed on the left or right eye, respectively. They are crucial for clarity in cases where the procedure is performed on only one eye.

4. -50 (Bilateral Procedure): This modifier is used when the procedure is performed on both eyes during the same session. It helps in indicating that both eyes were examined and documented.

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. This could be relevant if other diagnostic procedures or treatments are performed in the same session.

6. -76 (Repeat Procedure by Same Physician): This modifier may be used if the fundus photography needs to be repeated in the same session due to technical issues or other factors necessitating a repeat of the photography.

7. -22 (Increased Procedural Services): This modifier can be used when the work required to perform the fundus photography is substantially greater than typically required. This might be due to severe ocular pathology that complicates the photography process.

Each of these modifiers provides specific information that helps in the accurate processing and reimbursement of claims for fundus photography. It's essential for billing personnel to understand and apply these modifiers correctly based on the specifics of how the service was rendered.

CPT Code 92250 Medicare Reimbursement

CPT code 92250 refers to "Fundus photography with interpretation and report." This procedure involves the use of photography for the screening and documentation of ocular conditions.

Medicare does reimburse for CPT code 92250, as it is commonly utilized in the management and diagnosis of various ocular diseases such as diabetic retinopathy, glaucoma, and age-related macular degeneration, which are prevalent in the Medicare population. Reimbursement, however, can be subject to certain conditions such as medical necessity, the presence of specific symptoms, or documented disease progression that necessitates the use of this diagnostic tool.

The reimbursement amount for CPT code 92250 can vary based on the Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the service is provided (facility vs. non-facility), and any applicable Medicare adjustments such as geographic practice cost indices. Generally, the national average Medicare reimbursement for this code can range from approximately $75 to $150. It is advisable for providers to check with their local MAC for specific reimbursement rates and any documentation requirements or coverage limitations that might affect the reimbursement for this service.

Are You Being Underpaid for 92250 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to analyze contracts and identify discrepancies down to specific CPT codes, such as 92250 for eye exams with photos, RevFind ensures that each service is reimbursed correctly according to your payer agreements. Schedule a demo today to see how RevFind can safeguard your earnings by ensuring full payment for every procedure billed.

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