CPT Code 92313

CPT code 92313 is a medical code used for billing contact lens fitting services.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 92313

CPT code 92313 is used to denote a contact lens fitting for a patient who requires a complex lens design. This includes lenses that are designed to correct more severe visual impairments, such as keratoconus or post-surgical corneal distortions. The code covers the professional services involved in fitting these specialized lenses, including the evaluation of the eye's surface, the selection of the appropriate lens, and the necessary adjustments to ensure a proper fit.

Does CPT 92313 Need a Modifier?

For CPT code 92313, 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 specify services that are performed on the left eye (LT) or the right eye (RT) respectively, if the fitting is only for one eye.

3. -E1 to -E4 - Eyelid Modifiers: These are used to specify the eyelid involved in the procedure:
- -E1 Upper left, eyelid
- -E2 Lower left, eyelid
- -E3 Upper right, eyelid
- -E4 Lower right, eyelid

4. -TC - Technical Component: This modifier is used when only the technical portion of the service is provided, and no professional component is involved.

5. -26 - Professional Component: Indicates that the provider is billing only for the professional component of the service, which involves supervision, interpretation, and a written report.

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 is 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 on the same day but by a different physician.

Each of these modifiers provides a way to specify details about the service provided, ensuring accurate billing and appropriate reimbursement for the services rendered.

CPT Code 92313 Medicare Reimbursement

CPT code 92313, which pertains to the fitting of a contact lens for the management of keratoconus, is generally not covered by Medicare. Medicare typically does not reimburse for routine vision services, including standard contact lens fittings. However, in cases where the contact lens fitting is considered medically necessary, such as for managing keratoconus, there might be exceptions.

For specific reimbursement amounts, it is crucial to check with the local Medicare Administrative Contractor (MAC) as these can vary by region and specific patient circumstances. It's also recommended to verify coverage and potential reimbursement through prior authorization processes to ensure that the services provided meet the criteria deemed medically necessary by Medicare.

Are You Being Underpaid for 92313 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 down to the CPT code level, including specific codes like 92313 for contact lens fitting. Schedule a demo today to see how RevFind can help you secure correct payments from each individual payer and safeguard your healthcare organization's financial health.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background