CPT code 92340 is used for billing the fitting of monofocal spectacles, typically by an eye care professional.
CPT code 92340 is used to denote the fitting of monofocal spectacles. This code is utilized by healthcare providers when a patient requires glasses with lenses that have a single prescription strength across the entire lens, typically used to correct vision for either distance or near focus, but not both.
For the CPT code 92340, which pertains to the fitting of monofocal spectacles, 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. -LT (Left side): Used when the service (fitting of spectacles) is performed only on the left eye.
2. -RT (Right side): Used when the service is performed only on the right eye.
3. -E1 (Upper left, eyelid): Indicates that the service involves the upper left eyelid, which might be relevant in specific fitting or adjustments related to monofocal lenses.
4. -E2 (Lower left, eyelid): Indicates that the service involves the lower left eyelid.
5. -E3 (Upper right, eyelid): Indicates that the service involves the upper right eyelid.
6. -E4 (Lower right, eyelid): Indicates that the service involves the lower right eyelid.
7. -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 fitting, a significant and separate evaluation and management service is performed.
8. -59 (Distinct procedural service): This modifier is used to indicate that the fitting of spectacles is distinct from other procedures/services performed on the same day.
Each of these modifiers helps in specifying the exact nature of the service provided, ensuring accurate billing and appropriate reimbursement from insurance providers. It's important for healthcare providers to use these modifiers correctly to avoid claim denials and to ensure compliance with billing regulations.
The CPT code 92340, which pertains to the fitting of monofocal spectacles, is generally reimbursable by Medicare under specific circumstances. Medicare typically covers this service when it is deemed medically necessary, such as after cataract surgery with intraocular lens placement. However, routine vision care, including standard eyeglasses fittings for non-surgical reasons, is not covered.
The reimbursement amount for CPT code 92340 can vary based on geographic location and the Medicare administrative contractor responsible for the region. Providers should verify the specific reimbursement rates in their locality through the Medicare Physician Fee Schedule (MPFS) lookup tool available on the CMS (Centers for Medicare & Medicaid Services) website.
It is crucial for healthcare providers to ensure that all claims for reimbursement of this code are accompanied by appropriate documentation demonstrating the medical necessity of the service to avoid denials and ensure compliance with Medicare guidelines.
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