CPT Code 92314

CPT code 92314 is a medical billing code used for prescribing contact lenses.

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What is CPT Code 92314

CPT code 92314 is used to denote the prescription of contact lenses. This code is applied when a healthcare provider, typically an optometrist or ophthalmologist, evaluates a patient's vision and eye health to determine the appropriate contact lens specifications. This process may include the selection of lens material, design, and fitting of the lenses to ensure proper vision correction and comfort.

Does CPT 92314 Need a Modifier?

For the CPT code 92314, which pertains to the prescription of contact lenses, modifiers may be necessary to provide additional information about the service provided. Here is an ordered list of relevant modifiers that could be used with this CPT code and the reasons for each:

1. -LT (Left Side) - Used to specify that the service (prescription of contact lenses) was performed on the left eye.
2. -RT (Right Side) - Used to specify that the service was performed on the right eye.
3. -EY (Eyes) - This modifier can be used when the service involves both eyes, although it's less commonly used in conjunction with -LT and -RT, which provide more specific location information.
4. -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) - This modifier is used if, on the same day as the contact lens prescription, a significant and separate evaluation and management service was also provided.
5. -22 (Increased Procedural Services) - Indicates that the work performed was substantially greater than typically required for the contact lens prescription, possibly due to complex patient needs or complications.

Each of these modifiers provides critical billing information that helps ensure appropriate reimbursement and documentation of the services rendered.

CPT Code 92314 Medicare Reimbursement

Medicare generally does not cover routine vision services, such as eyeglasses and contact lenses. The CPT code 92314, which relates to the prescription of contact lenses, typically falls under these non-covered services. Therefore, Medicare does not reimburse for this CPT code when it is used for routine prescription of contact lenses.

However, there are exceptions where Medicare may cover contact lenses or eyeglasses, specifically after cataract surgery that implants an intraocular lens. In such cases, Medicare Part B may cover one pair of eyeglasses or one set of contact lenses provided by an ophthalmologist. This coverage is limited to standard frames and lenses, and additional costs for upgraded frames or enhanced lenses must be borne by the patient.

For routine prescriptions not associated with post-cataract surgery, patients will likely need to seek alternative methods of coverage or pay out-of-pocket for the contact lenses prescribed under CPT code 92314.

Are You Being Underpaid for 92314 CPT Code?

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