CPT Code 92317

CPT code 92317 is for the prescription of a corneoscleral contact lens.

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What is CPT Code 92317

CPT code 92317 is used to denote the prescription of a corneoscleral contact lens. This code is utilized when a healthcare provider prescribes a specific type of contact lens that covers both the cornea and the sclera of the eye, typically used to manage and treat various eye conditions that cannot be corrected with standard contact lenses.

Does CPT 92317 Need a Modifier?

For the CPT code 92317, which pertains to the prescription of corneoscleral contact lenses, several modifiers may be applicable depending on the specific billing circumstances and payer requirements. Here is an ordered list of potential modifiers and the reasons for their use:

1. -RT (Right Side) and -LT (Left Side): These modifiers are used to specify which eye the contact lens is for. Since contact lenses can be prescribed for one or both eyes, specifying the side is crucial for accurate billing and reimbursement.

2. -EY (Eyes): This modifier is used when the service (prescription or fitting) involves both eyes. It helps in distinguishing from unilateral fittings or prescriptions.

3. -TC (Technical Component): This modifier might be used if only the technical portion of the contact lens fitting is being billed, and not the professional component. This is applicable in scenarios where the equipment use is billed separately from the professional service.

4. -26 (Professional Component): Used when only the professional service of prescribing or fitting the lens is billed, separate from the use of any facility or equipment.

5. -22 (Increased Procedural Services): This modifier could be applied if the service provided is more complex or requires more effort than typically required. This might be relevant if there are special circumstances or complications in the fitting of the corneoscleral contact lenses.

6. -52 (Reduced Services): Used when the service provided is less than what is usually covered by the specific CPT code, which might be applicable if only a partial fitting or follow-up is performed.

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. This could be relevant if multiple procedures or fittings are done on the same day but are unrelated.

Each of these modifiers serves to provide specific, necessary details that affect how the service is billed and reimbursed, ensuring clarity and preventing billing errors. It's important to check with specific payer policies as the applicability of modifiers can vary.

CPT Code 92317 Medicare Reimbursement

CPT code 92317, which pertains to the prescription of a corneoscleral contact lens, is not typically reimbursed by Medicare. Medicare generally does not cover contact lenses or eyeglasses except under specific circumstances, such as post-cataract surgery with intraocular lens placement. In cases where contact lenses are covered, it is usually because they are considered prosthetic devices that are essential following surgical procedures.

For routine vision care and corrective lenses, Medicare beneficiaries are usually responsible for 100% of costs, unless they have additional vision coverage through Medicare Advantage plans or other private insurance policies. It's important for healthcare providers to verify coverage specifics with Medicare or the respective Medicare Advantage plan to confirm whether there is any exception or additional coverage for CPT code 92317 in particular cases.

Are You Being Underpaid for 92317 CPT Code?

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