CPT Code 92390

CPT code 92390 is a billing code used to denote the supply of spectacles in healthcare invoicing.

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What is CPT Code 92390

CPT code 92390 is designated for the supply of spectacles, excluding spectacles provided by an ophthalmologist or optometrist as part of patient care. This code is used specifically when spectacles are provided as a separate service, not directly linked to a medical examination or treatment by these professionals.

Does CPT 92390 Need a Modifier?

For the CPT code 92390, which is associated with the supply of spectacles, certain modifiers may be applicable depending on the specific billing circumstances and payer requirements. Here is an ordered list of common modifiers that might be used with this CPT code and the reasons for each:

1. LT (Left Side) - Used to specify that the service or item pertains only to the left side of the body. This can be important for billing purposes when only one spectacle or a component for the left eye is provided.

2. RT (Right Side) - Similar to the LT modifier, this is used to indicate that the service or item is for the right side of the body. This is necessary when the provision is specific to the right eye.

3. NU (New Equipment) - This modifier is used to indicate that the spectacles supplied are brand new. It differentiates from supplies that might be rented or used.

4. RA (Replacement of a DME Item) - If the spectacles are being provided as a replacement for a previously issued item, this modifier would be appropriate. It helps in clarifying that the claim is for a replacement rather than a new provision.

5. EY (No Physician or Other Licensed Health Care Provider Order for this Item or Service) - This modifier might be used if the spectacles are supplied without a direct order from a physician or another healthcare provider, which might be relevant in certain administrative contexts or specific insurance policy rules.

Each of these modifiers serves to provide additional details that can affect how a claim is processed and reimbursed. It's important to use the correct modifier to ensure accurate billing and to avoid delays in payment. Always check with specific payer guidelines to determine the necessity and appropriateness of each modifier for your billing situation.

CPT Code 92390 Medicare Reimbursement

CPT code 92390, which pertains to the supply of spectacles, is not typically reimbursed by Medicare. Medicare generally does not cover routine vision services, including eyeglasses or 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 uncoated prescription lenses and a basic set of frames.

For routine eyewear not linked to covered post-surgical care, patients are usually responsible for the full cost. Therefore, for CPT code 92390 under regular circumstances, there would be no reimbursement from Medicare. Providers should inform patients about this non-coverage to manage expectations and discuss potential out-of-pocket costs.

Are You Being Underpaid for 92390 CPT Code?

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