CPT Code 92310

CPT code 92310 is for evaluating the fit of contact lenses, including follow-up visits.

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What is CPT Code 92310

CPT code 92310 is designated for the evaluation and fitting of contact lenses. This includes both the initial fitting and the follow-up care necessary to ensure the contact lens is suitable for the patient's vision correction needs and eye health. This code is used by healthcare providers to bill for the professional services related to assessing the fit of the contact lenses, instructing the patient on proper usage, and any adjustments needed to optimize vision and comfort.

Does CPT 92310 Need a Modifier?

For CPT code 92310, which is used for contact lens fitting, several modifiers may be applicable depending on the specific circumstances of the service provided. Here is an ordered list of common modifiers that could be used with this code and the reasons for each:

1. -25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: This modifier is used if the provider performs a significant, separate evaluation and management service on the same day as the contact lens fitting.

2. -LT and -RT - Left Side and Right Side: These modifiers are used to specify services performed on the left eye (LT) or the right eye (RT) when the fitting is only for one eye.

3. -E1 to -E4 - Eyelid Modifiers:
- -E1 - Upper left, eyelid
- -E2 - Lower left, eyelid
- -E3 - Upper right, eyelid
- -E4 - Lower right, eyelid
These are used if the fitting or service specifically involves the eyelids and there is a need to specify which eyelid was involved in the procedure.

4. -TC - Technical Component: This modifier is used when only the technical portion of the service is provided, and not the professional component.

5. -22 - Increased Procedural Services: This modifier is used when the work required to provide the contact lens fitting is substantially greater than typically required.

6. -52 - Reduced Services: This modifier is used when the service provided is less than what is usually covered by the specific CPT code (e.g., if only one eye is fitted when the code typically covers both).

7. -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.

Each of these modifiers serves to provide additional information that can affect billing and reimbursement, ensuring that the services rendered are accurately documented and charged.

CPT Code 92310 Medicare Reimbursement

CPT code 92310, which pertains to contact lens fitting, is generally not reimbursed by Medicare. Medicare typically does not cover routine vision services, including eye refractions and contact lens fittings, as these are considered non-medical necessities. Therefore, services related to the prescription and fitting of contact lenses are usually out-of-pocket expenses for patients unless they have additional vision insurance that covers such services.

However, it's important for healthcare providers to verify coverage specifics directly with Medicare or through the Medicare Administrative Contractor (MAC) in their region, as there could be exceptions based on individual patient circumstances or additional qualifiers under which Medicare might cover such services (e.g., post-surgical treatments requiring contact lenses).

Are You Being Underpaid for 92310 CPT Code?

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