CPT Code 92354

CPT code 92354 is a medical billing code used for fitting single vision spectacles.

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What is CPT Code 92354

CPT code 92354 is designated for the fitting of spectacles, specifically focusing on a single vision system. This involves the selection and adjustment of eyeglass frames and lenses to correct the patient's vision using a single focal point throughout the entire lens. This service is typically provided by an optometrist or ophthalmologist.

Does CPT 92354 Need a Modifier?

For the CPT code 92354, which pertains to the fitting of spectacles (single vision system), 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 or procedure is performed only on the left side of the body. This modifier would be applicable if the spectacle fitting is only for the left eye.

2. -RT (Right Side): Used when the service or procedure is performed only on the right side of the body. This modifier would be applicable if the spectacle fitting is only for the right eye.

3. -E1 (Upper Left, Eyelid): This modifier can be used to specify that the service pertains to the upper left eyelid, which might be relevant in cases where the fitting of the spectacles affects or is affected by the condition of the eyelid.

4. -E2 (Lower Left, Eyelid): Similar to -E1, but for the lower left eyelid. This could be relevant for spectacle fittings that involve considerations around the lower eyelid.

5. -E3 (Upper Right, Eyelid): This modifier is used for services affecting the upper right eyelid, which could be pertinent in spectacle fittings, especially if there are unique conditions or treatments involving this area.

6. -E4 (Lower Right, Eyelid): Used for specifying services related to the lower right eyelid. This might be necessary if the fitting of the spectacles has implications for 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 when a significant, separately identifiable E/M service is performed on the same day as the fitting. This could be relevant if the patient requires a comprehensive evaluation for other eye-related issues on the same day as the fitting.

8. -59 (Distinct Procedural Service): Indicates that a service or procedure was distinct or independent from other services performed on the same day. This modifier might be used if the spectacle fitting is performed in conjunction with another, separate procedure that is not typically bundled together.

Each of these modifiers provides a way to specify details about the service provided, ensuring accurate documentation and billing for the services rendered. It's important for healthcare providers to select the appropriate modifier(s) based on the specific clinical circumstances surrounding each individual patient's treatment.

CPT Code 92354 Medicare Reimbursement

The CPT code 92354, which pertains to the fitting of spectacles (single vision system), is generally not reimbursed by Medicare. Medicare typically does not cover routine vision services, including eyeglasses and contact lenses, except under specific circumstances, such as post-cataract surgery with intraocular lens placement. In such cases, Medicare may cover a standard pair of prescription glasses or contact lenses, but otherwise, eyewear is not covered.

For healthcare providers, it's important to inform patients about these limitations in Medicare coverage and discuss alternative payment options or potential coverage through supplementary insurance if applicable. Always verify the specific details of coverage through the patient's Medicare plan or any additional insurance policies they might have.

Are You Being Underpaid for 92354 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to read your contracts and identify discrepancies down to specific CPT codes, such as 92354 for fitting spectacles in a single system, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to from each individual payer.

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