CPT Code 92287

CPT code 92287 is used for billing internal eye photography, essential for diagnosing eye conditions.

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What is CPT Code 92287

CPT code 92287 is designated for special anterior segment photography with interpretation and report. This procedure involves the use of imaging techniques to capture detailed photos of the front part of the eye, including the iris, cornea, and lens. These images are typically used to assist in diagnosing, monitoring, and managing various eye conditions. The code includes both the technical aspect of taking the photographs and the professional component of interpreting the images and providing a detailed report.

Does CPT 92287 Need a Modifier?

For CPT code 92287 (Internal eye photography with interpretation and report), the application of modifiers can be essential depending on the specific circumstances of the billing scenario. Here is an ordered list of common modifiers that might be used with this code and the reasons for each:

1. -26 (Professional Component): Used when only the professional service was provided, such as the interpretation of the internal eye photography by a physician, but the equipment or facility was not provided by the physician or the physician's practice.

2. -TC (Technical Component): Applied when only the technical service was provided, such as the actual taking of the internal eye photographs, but the interpretation is done by another provider.

3. -LT (Left side) and -RT (Right side): These modifiers are used to specify which eye was photographed if only one eye was involved in the procedure.

4. -50 (Bilateral Procedure): Used if the procedure was performed on both eyes during the same session. This modifier helps in indicating that the service was a bilateral procedure, which can affect reimbursement.

5. -59 (Distinct Procedural Service): This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. This can be necessary if the internal eye photography is performed in conjunction with other procedures.

6. -76 (Repeat Procedure by Same Physician): Used if the procedure is repeated by the same physician on the same day, which might occur if initial images were inadequate for diagnostic purposes.

7. -77 (Repeat Procedure by Another Physician): Applied when the procedure is repeated by a different physician on the same day.

8. -22 (Increased Procedural Services): This modifier may be used when the work required to perform the procedure is substantially greater than typically required.

Each modifier has specific guidelines for use and should be applied correctly to ensure accurate billing and optimal reimbursement. It's important for billing and coding professionals to verify the necessity and correctness of each modifier based on the clinical and billing context.

CPT Code 92287 Medicare Reimbursement

CPT code 92287, which refers to internal eye photography with interpretation and report, is typically reimbursed by Medicare under certain conditions. This procedure is generally covered when it is deemed medically necessary for diagnosing or monitoring a disease involving the eye.

The reimbursement for CPT code 92287 can vary based on the Medicare Administrative Contractor (MAC) jurisdiction, geographic location, and the setting in which the service is provided (e.g., outpatient hospital, physician’s office). To determine the specific reimbursement amount, it is advisable to check with the local MAC or utilize the Medicare Physician Fee Schedule Look-Up Tool available on the CMS (Centers for Medicare & Medicaid Services) website.

Providers should ensure that proper documentation is maintained to justify the medical necessity of the procedure to avoid denials. Additionally, adherence to any specific billing guidelines provided by Medicare for this CPT code is crucial for securing reimbursement.

Are You Being Underpaid for 92287 CPT Code?

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