CPT Code 92312

CPT code 92312 is used to bill for the professional service of fitting contact lenses.

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What is CPT Code 92312

CPT code 92312 is designated for the professional service of fitting a contact lens for one eye, which includes both the initial and subsequent fitting sessions. This code is used by healthcare providers to bill for the time and expertise required to ensure the contact lens fits properly, functions effectively, and meets the patient's vision correction needs.

Does CPT 92312 Need a Modifier?

For CPT code 92312, which pertains to contact lens fitting, several modifiers may be applicable depending on the specific circumstances of the service provided. Here is an ordered list of potential modifiers and the reasons for their use:

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 indicate services performed on the left eye (LT) or the right eye (RT) respectively, which is crucial in treatments specific to each eye.

3. -E1 to -E4 - Eyelid Modifiers:
- -E1 - Upper left, eyelid
- -E2 - Lower left, eyelid
- -E3 - Upper right, eyelid
- -E4 - Lower right, eyelid
These eyelid-specific modifiers could be relevant if the fitting involves specific eyelid measurements or considerations.

4. -TC - Technical Component: This modifier is used when only the technical portion of the service (i.e., the use of equipment for fitting) is provided without the professional component.

5. -26 - Professional Component: Indicates that the service provided was purely professional (i.e., the expertise or judgment of the provider) without the use of equipment which is typically part of the service.

6. -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.

7. -76 - Repeat Procedure by Same Physician: This modifier could be used if the contact lens fitting needs to be repeated on the same day by the same physician.

8. -77 - Repeat Procedure by Another Physician: Used if the contact lens fitting is repeated by a different physician on the same day.

Each of these modifiers serves to provide additional details about the specific circumstances under which the contact lens fitting was performed, ensuring accurate billing and appropriate reimbursement for the services rendered.

CPT Code 92312 Medicare Reimbursement

CPT code 92312, which pertains to contact lens fitting, is generally not reimbursed by Medicare. Medicare typically does not cover routine vision services, including the fitting and purchase of contact lenses, as these are considered non-medical and elective procedures. Medicare coverage is primarily focused on medically necessary services and treatments. Therefore, services related to routine eye care, such as contact lens fitting, are usually excluded from coverage.

For healthcare providers, it's important to communicate to patients that they will likely be responsible for the full cost of these services, as Medicare will not provide reimbursement. Additionally, providers should verify coverage specifics with any supplemental insurance plans the patient may have that could potentially cover such services.

Are You Being Underpaid for 92312 CPT Code?

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