CPT code 92275 is used for billing electroretinography, a diagnostic test measuring the electrical response of the eye's light-sensitive cells.
CPT code 92275 is designated for electroretinography, a diagnostic test that measures the electrical response of the eye's light-sensitive cells, called rods and cones, to light stimuli. This procedure is used to assess the function of the retina, helping in the diagnosis and management of conditions affecting retinal health, such as retinitis pigmentosa or other degenerative eye diseases.
For CPT code 92275, which pertains to electroretinography, several modifiers may be applicable depending on the specific circumstances of the procedure performed. Here is an ordered list of common modifiers that could 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 or facilities 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 healthcare provider, but the interpretive services are provided by another physician.
3. -LT (Left Side) and -RT (Right Side): These modifiers are used to specify which eye was tested if only one eye was examined.
4. -50 (Bilateral Procedure): This modifier is used when the procedure is performed on both eyes during the same session. It is important to check payer policies as some may require the use of -LT and -RT instead of -50.
5. -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. This might be applicable if electroretinography is performed along with other diagnostic tests that are usually not reported together.
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 may be necessary if the initial test results were inconclusive or if there was some issue with the test performance.
7. -77 (Repeat Procedure by Another Physician): Similar to -76, but used when the procedure is repeated by a different physician on the same day.
8. -22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to extenuating circumstances like patient non-compliance, severe disease state, or other complicating factors.
Each of these modifiers provides specific information that affects billing and reimbursement and should be used accurately to reflect the exact nature of the service provided. Always verify with specific payer policies as the acceptability and interpretation of modifiers can vary.
CPT code 92275, which refers to electroretinography, is generally reimbursed by Medicare. However, the reimbursement for this procedure can vary based on the specific Medicare Administrative Contractor (MAC) that governs the region in which the service is provided. It's important for healthcare providers to check with their local MAC for specific coverage details, including any documentation requirements or limitations on coverage.
As for the reimbursement amount, this can also vary depending on the geographic location and the setting in which the service is provided (e.g., hospital outpatient department vs. a physician's office). To obtain the most accurate and up-to-date reimbursement rates, providers should use the Medicare Physician Fee Schedule Look-Up Tool available on the CMS (Centers for Medicare & Medicaid Services) website. This tool allows providers to input the specific CPT code and their geographic location to retrieve current reimbursement rates.
It's also crucial to note that while Medicare may reimburse for this procedure, there may be additional guidelines or prerequisites for coverage, such as indications of medical necessity or prior authorization requirements. Providers should ensure that these conditions are met to facilitate appropriate reimbursement.
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