CPT Code 92355

CPT code 92355 is used for billing the fitting of spectacles with compound lenses.

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What is CPT Code 92355

CPT code 92355 is used to denote the service of fitting spectacles with compound lenses. This involves the precise adjustment and alignment of lenses that have multiple focal points, catering to specific optical needs such as correcting vision for both nearsightedness and farsightedness in the same lens. This code is utilized by healthcare providers when billing for the professional service involved in ensuring the spectacles meet the individual's visual requirements.

Does CPT 92355 Need a Modifier?

For the CPT code 92355, which pertains to the fitting of spectacles with compound lenses, 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 side. This modifier helps in specifying which eye the compound lens fitting was performed on, ensuring accurate billing and documentation.

2. -RT (Right Side): Similar to the -LT modifier, this is used when the service is performed only on the right side. It is crucial for claims accuracy to indicate the specific side when only one eye is involved in the fitting.

3. -50 (Bilateral Procedure): This modifier is used when the fitting involves both eyes. It is important for billing purposes as some payers may have different reimbursement policies for bilateral procedures.

4. -22 (Increased Procedural Services): If the fitting of the spectacles with compound lenses involves extra effort or complexity beyond the usual service, this modifier can be added to indicate that the procedure was more extensive than typically expected.

5. -52 (Reduced Services): If the service provided is less than what is usually required for this CPT code (for instance, if only a partial fitting was possible or needed), this modifier would be appropriate to reflect the reduced nature of the service.

6. -TC (Technical Component): This could be applicable if the fitting involves specific technical equipment or personnel, and the billing is split between technical and professional components. This modifier would be used to bill for the technical part only.

7. -26 (Professional Component): Conversely to the -TC modifier, this is used when billing for the professional service component of the fitting, excluding any technical aspects.

Each of these modifiers provides a way to specify the exact nature of the service provided, ensuring that billing is accurate and reflective of the actual services rendered. It is essential for healthcare providers to use these modifiers correctly to avoid claim denials and to facilitate appropriate reimbursement from insurance carriers.

CPT Code 92355 Medicare Reimbursement

CPT code 92355, which pertains to the fitting of spectacles with compound lenses, 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 eyeglasses or contact lenses, but not necessarily those involving compound lenses or specialized fittings beyond the basic requirement.

For healthcare providers, it's important to verify coverage specifics directly with Medicare or through the Medicare Administrative Contractor (MAC) that manages your region, as there might be exceptions or specific conditions under which coverage could be different. Additionally, providers should inform patients about potential out-of-pocket costs for services and materials not covered by Medicare.

Are You Being Underpaid for 92355 CPT Code?

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