CPT Code 92284

CPT code 92284 is for a diagnostic exam that assesses eye response to varying light levels.

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What is CPT Code 92284

CPT code 92284 is designated for a diagnostic examination specifically focused on dark adaptation. This involves testing and recording the eye's ability to adjust to darkness, which can help in assessing retinal function and diagnosing conditions like night blindness and other visual impairments related to low-light environments. The "i&r" in the description stands for "initial and repeat," indicating that this code may be used for both the initial examination and subsequent repeat tests to monitor changes or improvements in dark adaptation.

Does CPT 92284 Need a Modifier?

For CPT code 92284, which is used for dark adaptation examination including interpretation and report, certain modifiers may be applicable depending on the specific circumstances of the billing situation. Here is an ordered list of common modifiers that might be used with this CPT code 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, but the technical component (the equipment and performance of the test) is provided by another entity.

2. -TC (Technical Component): Conversely, this modifier is used when only the technical component of the service is provided, and the professional component is handled by another provider.

3. -LT (Left Side) and -RT (Right Side): These modifiers are used to specify which eye was examined if only one eye was tested.

4. -50 (Bilateral Procedure): If the examination is performed on both eyes during the same session, this modifier should be used to indicate a bilateral procedure.

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.

6. -76 (Repeat Procedure by Same Physician): This modifier is used if the test is repeated on the same day by the same physician.

7. -77 (Repeat Procedure by Another Physician): This modifier is used if the test is repeated on the same day but by a different physician.

8. -22 (Increased Procedural Services): If the service provided is more complex or requires more effort than typically required, this modifier can be used to indicate an increased service level.

9. -52 (Reduced Services): If the service provided is less than what is usually required for the 92284 CPT code, this modifier may be used to indicate reduced services.

Each of these modifiers provides specific information that helps in the accurate processing and reimbursement of claims for dark adaptation exams. It's important to choose the correct modifier(s) based on the specific circumstances of the service provided to ensure proper billing and to avoid claim denials.

CPT Code 92284 Medicare Reimbursement

The CPT code 92284, which pertains to a dark adaptation examination including recording, is generally reimbursable by Medicare. However, the specific coverage and reimbursement rates can vary based on the Medicare Administrative Contractor (MAC) that governs the region in which the service is provided. It is essential for healthcare providers to verify the coverage specifics with their local MAC.

As for the reimbursement amount, it can fluctuate based on the geographic location and the fee schedule set by Medicare for that particular year. Providers can find the most accurate and up-to-date reimbursement rates by consulting the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or through their MAC's portal.

It is also important to ensure that the documentation supports the medical necessity of the procedure, as this is a critical factor in securing reimbursement from Medicare. Proper coding and adherence to Medicare guidelines are crucial to optimize revenue cycle management in this context.

Are You Being Underpaid for 92284 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments with precision. With the capability to drill down to specific CPT codes, such as 92284 for Dx dark adaptation exams, RevFind ensures that each claim is reimbursed correctly according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every service rendered.

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