CPT Code 92335

CPT code 92335 is a medical billing code for the fitting of an artificial eye.

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What is CPT Code 92335

CPT code 92335 is designated for the procedure involving the fitting of an artificial eye. This code is used by healthcare providers to bill for the service of fitting a prosthetic eye, ensuring it is customized and comfortable for the patient. This procedure typically includes the selection of the appropriate size, shape, and color of the artificial eye, along with adjustments for optimal fit and appearance.

Does CPT 92335 Need a Modifier?

For CPT code 92335, which involves the fitting of an artificial eye, several modifiers may be applicable depending on the specific circumstances of the service provided. Here’s an ordered list of potential modifiers and the reasons for their use:

1. -LT (Left side): Used when the service is performed on the left eye.
2. -RT (Right side): Used when the service is performed on the right eye.
3. -22 (Increased Procedural Services): This modifier is used when the work required to fit the artificial eye is substantially greater than typically required. Documentation must support the extra work and the reason for it.
4. -52 (Reduced Services): Applied when the service provided is less extensive than usually required for this code. This might be relevant if only a partial adjustment or minor fitting is done.
5. -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This could be applicable if the fitting of the artificial eye is part of a planned sequence of treatments following an initial procedure.
6. -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Used if a return to the procedure room is needed unexpectedly to adjust or refit the artificial eye within the postoperative period.
7. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If another, unrelated procedure is performed by the same physician during the postoperative period of the initial fitting, this modifier would be appropriate.

Each of these modifiers provides a way to specify the details of the procedure to ensure accurate billing and appropriate reimbursement. It’s important to document the reasons for using any modifiers to support the claims made to insurance providers.

CPT Code 92335 Medicare Reimbursement

CPT code 92335, which pertains to the fitting of an artificial eye, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on the Medicare Administrative Contractor (MAC) that services the geographical area where the service is provided. Providers should verify coverage and reimbursement rates with their local MAC to ensure accurate billing and to understand the specific reimbursement details for their region. Additionally, it's important to ensure that all necessary documentation and medical necessity justifications are properly submitted to facilitate the reimbursement process.

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